MEDICARE: LINEEQUA PAULINAE 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	172A00000X	Driver	TG076497	OH

General Provider Information

NPI Number	:	1518744028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINEEQUA PAULINAE MILLER

Provider Business Mailing Address
First Line	:	2369 WALDEN GLEN CIR APT C
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1439
Country	:	US
Telephone Number	:	513-390-0037
Fax Number	:

Provider Business Practice Location Address
First Line	:	2369 WALDEN GLEN CIR APT C
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1439
Country	:	US
Telephone Number	:	513-390-0037
Fax Number	:

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

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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