MEDICARE: MR. WILLIAM LAVANT MILLER 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
1	164W00000X	Licensed Practical Nurse	127712	OH

General Provider Information

NPI Number	:	1982888921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM LAVANT MILLER LPN

Provider Business Mailing Address
First Line	:	PO BOX 523
Second Line	:
City	:	NORTH KINGSVILLE
State	:	OH
Zip	:	44068-0523
Country	:	US
Telephone Number	:	440-224-2480
Fax Number	:	775-908-5339

Provider Business Practice Location Address
First Line	:	6329 GREEN ROAD
Second Line	:
City	:	NORTH KINGSVILLE
State	:	OH
Zip	:	44068-0523
Country	:	US
Telephone Number	:	440-224-2480
Fax Number	:	775-908-5339

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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