Healthcare Provider Details

I. General information

NPI: 1235542770
Provider Name (Legal Business Name): JACKIE ELAINE MILLER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 CANTON RD
AKRON OH
44312-4074
US

IV. Provider business mailing address

1880 CANTON RD
AKRON OH
44312-4074
US

V. Phone/Fax

Practice location:
  • Phone: 330-798-1002
  • Fax: 330-798-1162
Mailing address:
  • Phone: 330-798-1002
  • Fax: 330-798-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN34766
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: