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NPI Code Detail

MEDICARE: THEODORE MILEY JR. LPN

MEDICARE: THEODORE MILEY JR. LPN
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
1164W00000XLicensed Practical Nurse75052NC

General Provider Information

NPI Number : 1699358812
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE MILEY JR. LPN
Provider Business Mailing Address
First Line : 200 NORTHVIEW PLZ
Second Line :
City : NORTH WILKESBORO
State : NC
Zip : 28659-3173
Country : US
Telephone Number : 336-818-0607
Fax Number :
Provider Business Practice Location Address
First Line : 200 NORTHVIEW PLZ
Second Line :
City : NORTH WILKESBORO
State : NC
Zip : 28659-3173
Country : US
Telephone Number : 336-818-0607
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2021
Last Update Date : 05/05/2021

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