Provider Demographics
NPI:1316494982
Name:MILLER, HOLLY (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASE MANAGER
Mailing Address - Street 1:216 NTH 8TH WEST
Mailing Address - Street 2:216 NTH 8TH WEST
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4940
Mailing Address - Country:US
Mailing Address - Phone:307-851-3955
Mailing Address - Fax:307-857-6974
Practice Address - Street 1:625 E MADISON AVE STE 6
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4712
Practice Address - Country:US
Practice Address - Phone:307-851-3955
Practice Address - Fax:307-857-6974
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator