Provider Demographics
NPI:1588366868
Name:MILLER, LAVERNE RENA'
Entity type:Individual
Prefix:
First Name:LAVERNE
Middle Name:RENA'
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-4058
Mailing Address - Country:US
Mailing Address - Phone:864-205-6139
Mailing Address - Fax:
Practice Address - Street 1:587 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-4058
Practice Address - Country:US
Practice Address - Phone:864-205-6139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide