Provider Demographics
NPI:1962772376
Name:MILLER, LEAH DAWN
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:DAWN
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 1:95 CRADDOCK FRK
Mailing Address - Street 2:
Mailing Address - City:LAKE
Mailing Address - State:WV
Mailing Address - Zip Code:25121-9601
Mailing Address - Country:US
Mailing Address - Phone:304-784-2739
Mailing Address - Fax:
Practice Address - Street 1:95 CRADDOCK FRK
Practice Address - Street 2:
Practice Address - City:LAKE
Practice Address - State:WV
Practice Address - Zip Code:25121-9601
Practice Address - Country:US
Practice Address - Phone:304-784-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator