Healthcare Provider Details

I. General information

NPI: 1144834144
Provider Name (Legal Business Name): CORINNE JAE MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8502 MORMON BRIDGE RD
OMAHA NE
68152-1929
US

IV. Provider business mailing address

20 S 41ST ST APT 148
COUNCIL BLUFFS IA
51501-3373
US

V. Phone/Fax

Practice location:
  • Phone: 402-455-8303
  • Fax:
Mailing address:
  • Phone: 712-621-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number152704
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: