Provider Demographics
NPI:1699923722
Name:MILLER, LANCE THEODORE (RN)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:THEODORE
Last Name:MILLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 MIDLAND AVE
Mailing Address - Street 2:APT #B35
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1409
Mailing Address - Country:US
Mailing Address - Phone:914-610-1148
Mailing Address - Fax:914-925-5013
Practice Address - Street 1:275 NORTH ST
Practice Address - Street 2:ST. VINCENT'S HOSPITAL WESTCHESTER
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528
Practice Address - Country:US
Practice Address - Phone:914-925-5460
Practice Address - Fax:914-925-5013
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY463523163WA0400X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)