Healthcare Provider Details

I. General information

NPI: 1548476088
Provider Name (Legal Business Name): MRS. VIRGINIA LUCILLE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5613 CONCORD RD
HILLSBORO OH
45133-9699
US

IV. Provider business mailing address

10839 HORSESHOE RD
LYNCHBURG OH
45142-9442
US

V. Phone/Fax

Practice location:
  • Phone: 937-393-6936
  • Fax:
Mailing address:
  • Phone: 937-364-6676
  • Fax: 937-364-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: