Provider Demographics
NPI:1336416098
Name:MILLER, ANGELA MARIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 KINSROW AVE
Mailing Address - Street 2:APT 110
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8006
Mailing Address - Country:US
Mailing Address - Phone:541-654-7569
Mailing Address - Fax:
Practice Address - Street 1:3515 KINSROW AVE
Practice Address - Street 2:APT 110
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8006
Practice Address - Country:US
Practice Address - Phone:541-654-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201130572LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse