Healthcare Provider Details

I. General information

NPI: 1164028312
Provider Name (Legal Business Name): MARVA RENEE MILLER RMA, HSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KOEHLER AVE APT 10
CINCINNATI OH
45215-4845
US

IV. Provider business mailing address

110 KOEHLER AVE APT 10
CINCINNATI OH
45215-4845
US

V. Phone/Fax

Practice location:
  • Phone: 513-226-4757
  • Fax:
Mailing address:
  • Phone: 513-226-4757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number322217280412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: