Provider Demographics
NPI:1487710521
Name:MILLER, GENE EDWARD (RN)
Entity type:Individual
Prefix:MR
First Name:GENE
Middle Name:EDWARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12125 CANTERBURY LOOP
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-4210
Mailing Address - Country:US
Mailing Address - Phone:540-776-1998
Mailing Address - Fax:
Practice Address - Street 1:2355A MILL RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4608
Practice Address - Country:US
Practice Address - Phone:703-838-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00011440001163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse