Healthcare Provider Details

I. General information

NPI: 1902333602
Provider Name (Legal Business Name): BILLIE J MILES CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 LAKEVIEW AVE
DANVILLE IL
61832-1033
US

IV. Provider business mailing address

425 LAKEVIEW AVE
DANVILLE IL
61832-1033
US

V. Phone/Fax

Practice location:
  • Phone: 217-260-7220
  • Fax:
Mailing address:
  • Phone: 217-260-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: