Healthcare Provider Details

I. General information

NPI: 1881506525
Provider Name (Legal Business Name): TAYLOR JADE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E INDIANA AVE APT 105
BISMARCK ND
58504-5773
US

IV. Provider business mailing address

128 E INDIANA AVE APT 105
BISMARCK ND
58504-5773
US

V. Phone/Fax

Practice location:
  • Phone: 701-389-8526
  • Fax:
Mailing address:
  • Phone: 701-389-8526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberMIL017607
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: