Provider Demographics
NPI:1962760538
Name:MILLER, CHARLES FRANKLIN (LPN)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FRANKLIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1665
Mailing Address - Country:US
Mailing Address - Phone:414-875-9732
Mailing Address - Fax:
Practice Address - Street 1:8750 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-1665
Practice Address - Country:US
Practice Address - Phone:414-875-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30509031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse