Healthcare Provider Details

I. General information

NPI: 1245435262
Provider Name (Legal Business Name): MRS. LISA JANE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4639 E MORELAND RD
FREDERICKSBURG OH
44627
US

IV. Provider business mailing address

PO BOX 195 137 JONES CIRCLE
FREDERICKSBURG OH
44627
US

V. Phone/Fax

Practice location:
  • Phone: 330-698-0444
  • Fax:
Mailing address:
  • Phone: 330-695-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: