MEDICARE: DONETH MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	309860	NY

General Provider Information

NPI Number	:	1508339417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONETH MILLER

Provider Business Mailing Address
First Line	:	140 ELGAR PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-5201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 ELGAR PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-5201
Country	:	US
Telephone Number	:	347-346-4959
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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Directions to “ DONETH MILLER ” Practice Location

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