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NPI Code Detail

MEDICARE: LESLIE MILLER

MEDICARE:   LESLIE  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
1164W00000XLicensed Practical NurseLO44435AR

General Provider Information

NPI Number : 1790430940
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE MILLER
Provider Business Mailing Address
First Line : 910 LIBERTY ST
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4322
Country : US
Telephone Number : 870-881-4607
Fax Number :
Provider Business Practice Location Address
First Line : 910 LIBERTY ST
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4322
Country : US
Telephone Number : 870-881-4607
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2022
Last Update Date : 02/16/2022

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Directions to “ LESLIE MILLER ” Practice Location

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