Healthcare Provider Details

I. General information

NPI: 1265264162
Provider Name (Legal Business Name): SIMOHN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 OLD MARLTON PIKE STE 124
MEDFORD NJ
08055-8772
US

IV. Provider business mailing address

103 OLD MARLTON PIKE STE 124
MEDFORD NJ
08055-8772
US

V. Phone/Fax

Practice location:
  • Phone: 888-575-9162
  • Fax:
Mailing address:
  • Phone: 888-575-9162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP07863200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: