Healthcare Provider Details

I. General information

NPI: 1386941920
Provider Name (Legal Business Name): LINDA K MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6294 STATE HIGHWAY 154
SESSER IL
62884
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-625-6679
  • Fax: 618-625-5362
Mailing address:
  • Phone: 618-724-1607
  • Fax: 618-724-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041143471
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: