Provider Demographics
NPI:1699046599
Name:MILLER, INGA
Entity type:Individual
Prefix:
First Name:INGA
Middle Name:
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:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-0603
Mailing Address - Country:US
Mailing Address - Phone:509-671-0929
Mailing Address - Fax:208-448-2808
Practice Address - Street 1:37 HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-6559
Practice Address - Country:US
Practice Address - Phone:509-671-0929
Practice Address - Fax:208-448-2808
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNO LICENSE REQUIRED225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist