Provider Demographics
NPI:1528614955
Name:MILLER, CHRISTOPHER WILLIAM
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WILLIAM
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 1:58255 ROY ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:WI
Mailing Address - Zip Code:54856-3016
Mailing Address - Country:US
Mailing Address - Phone:715-765-4333
Mailing Address - Fax:715-765-4303
Practice Address - Street 1:58255 ROY ANDERSON RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:WI
Practice Address - Zip Code:54856-3016
Practice Address - Country:US
Practice Address - Phone:715-765-4333
Practice Address - Fax:715-765-4303
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WINA284001374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide