Healthcare Provider Details

I. General information

NPI: 1255328829
Provider Name (Legal Business Name): JANET L MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 B ST
PLUMMER ID
83851
US

IV. Provider business mailing address

1115 B ST
PLUMMER ID
83851
US

V. Phone/Fax

Practice location:
  • Phone: 208-686-1931
  • Fax: 208-656-5133
Mailing address:
  • Phone: 208-686-1931
  • Fax: 208-656-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: