Healthcare Provider Details

I. General information

NPI: 1093619694
Provider Name (Legal Business Name): ANNETTE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N JACKSON ST
JACKSON MI
49201-1223
US

IV. Provider business mailing address

500 N JACKSON ST
JACKSON MI
49201-1223
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-5445
  • Fax:
Mailing address:
  • Phone: 517-748-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902020619
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: