Healthcare Provider Details

I. General information

NPI: 1851274153
Provider Name (Legal Business Name): MRS. LUCILLE ROSE MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 GARY LN
WILLINGBORO NJ
08046-3018
US

IV. Provider business mailing address

30 GARY LN
WILLINGBORO NJ
08046-3018
US

V. Phone/Fax

Practice location:
  • Phone: 609-224-5684
  • Fax:
Mailing address:
  • Phone: 609-665-9812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: