Healthcare Provider Details

I. General information

NPI: 1386184430
Provider Name (Legal Business Name): JESSICA MILES RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

4777 PARKWEST DR
SAN JOSE CA
95130-1045
US

V. Phone/Fax

Practice location:
  • Phone: 608-443-8696
  • Fax:
Mailing address:
  • Phone: 608-443-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number4167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: