Healthcare Provider Details

I. General information

NPI: 1457637779
Provider Name (Legal Business Name): MS. JENNA LEANNE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA BARNES

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 360
ALBUQUERQUE NM
87102-5317
US

IV. Provider business mailing address

3003 ADAMS ST NE APT K17
ALBUQUERQUE NM
87110-8005
US

V. Phone/Fax

Practice location:
  • Phone: 505-557-4656
  • Fax: 505-514-0874
Mailing address:
  • Phone: 575-640-1264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-08047
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: