Provider Demographics
NPI:1417790007
Name:MILLER, JARED
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6713 MADISON RD APT B
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:OH
Mailing Address - Zip Code:44086-8773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8460 DEWEY RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44064-9719
Practice Address - Country:US
Practice Address - Phone:440-417-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion