Healthcare Provider Details

I. General information

NPI: 1982203014
Provider Name (Legal Business Name): EILEEN JOAN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 SAINT ABIGAIL ST SW
HARTVILLE OH
44632-8542
US

IV. Provider business mailing address

1202 SAINT ABIGAIL ST SW
HARTVILLE OH
44632-8542
US

V. Phone/Fax

Practice location:
  • Phone: 330-607-6348
  • Fax:
Mailing address:
  • Phone: 330-607-6348
  • 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: