Healthcare Provider Details

I. General information

NPI: 1760930259
Provider Name (Legal Business Name): MS. AMY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY MILLER UDDO RNFA,CNOR

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 TOKALON PL
METAIRIE LA
70001-3020
US

IV. Provider business mailing address

38 TOKALON PL
METAIRIE LA
70001-3020
US

V. Phone/Fax

Practice location:
  • Phone: 504-914-4453
  • Fax:
Mailing address:
  • Phone: 504-914-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN111112
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: