Healthcare Provider Details

I. General information

NPI: 1346510732
Provider Name (Legal Business Name): MARYJANE ANN MILLER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/04/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 LAUREL ST
ROME NY
13440-3229
US

IV. Provider business mailing address

801 LAUREL ST
ROME NY
13440-3229
US

V. Phone/Fax

Practice location:
  • Phone: 315-338-5214
  • Fax: 315-334-7465
Mailing address:
  • Phone: 315-338-5214
  • Fax: 315-334-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number22242267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: