Healthcare Provider Details

I. General information

NPI: 1194654046
Provider Name (Legal Business Name): MARY E MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25026 CONSTITUTION AVE
WARREN MI
48089-2080
US

IV. Provider business mailing address

25026 CONSTITUTION AVE
WARREN MI
48089-2080
US

V. Phone/Fax

Practice location:
  • Phone: 313-205-8205
  • Fax: 313-205-8205
Mailing address:
  • Phone: 313-205-8205
  • Fax: 313-205-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: