Healthcare Provider Details

I. General information

NPI: 1154659571
Provider Name (Legal Business Name): BONNIE LEWIS MILLER R.N. BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16703 ASHTON AVE
DETROIT MI
48219-4144
US

IV. Provider business mailing address

16703 ASHTON AVE
DETROIT MI
48219-4144
US

V. Phone/Fax

Practice location:
  • Phone: 313-538-7222
  • Fax:
Mailing address:
  • Phone: 313-538-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704073195
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number4704073195
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number4704073195
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number4704073195
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number4704073195
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number4704073195
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number4704073195
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number4704073195
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: