Provider Demographics
NPI:1962170647
Name:MILLER, MADELINE GRACE (RDN)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:GRACE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4108
Mailing Address - Country:US
Mailing Address - Phone:585-857-4555
Mailing Address - Fax:
Practice Address - Street 1:9 VIRGINIA LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4108
Practice Address - Country:US
Practice Address - Phone:585-857-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered