Healthcare Provider Details

I. General information

NPI: 1912559766
Provider Name (Legal Business Name): MISS NICOLE MICHELLE MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 S FRANCISCO AVE
CHICAGO IL
60652-2727
US

IV. Provider business mailing address

8008 S FRANCISCO AVE
CHICAGO IL
60652-2727
US

V. Phone/Fax

Practice location:
  • Phone: 773-369-4554
  • Fax:
Mailing address:
  • Phone: 773-369-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number307946
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: