Healthcare Provider Details

I. General information

NPI: 1013148295
Provider Name (Legal Business Name): CLARA MAY MILLER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 BONNIE BRAE PL
RIVER FOREST IL
60305-1513
US

IV. Provider business mailing address

1025 BONNIE BRAE PL
RIVER FOREST IL
60305-1513
US

V. Phone/Fax

Practice location:
  • Phone: 708-366-8119
  • Fax:
Mailing address:
  • Phone: 708-366-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number041118829
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: