Healthcare Provider Details

I. General information

NPI: 1023596343
Provider Name (Legal Business Name): JENNIFER LAUREN LEE MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 W 9TH ST APT 312
CLEVELAND OH
44113
US

IV. Provider business mailing address

1810 W 25TH ST UNIT 1
CLEVELAND OH
44113-3152
US

V. Phone/Fax

Practice location:
  • Phone: 513-503-4208
  • Fax:
Mailing address:
  • Phone: 216-685-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number023114
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: