Provider Demographics
NPI:1588985667
Name:MILLER, SHANNA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:MARIE
Other - Last Name:JOYNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:1401 WEST ST
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7819
Mailing Address - Country:US
Mailing Address - Phone:334-559-5579
Mailing Address - Fax:334-826-7937
Practice Address - Street 1:1401 WEST ST
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7819
Practice Address - Country:US
Practice Address - Phone:334-559-5579
Practice Address - Fax:334-826-7937
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-060174164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse