Healthcare Provider Details

I. General information

NPI: 1992257794
Provider Name (Legal Business Name): CHAD MILEY CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 RICHLAND MALL
ONTARIO OH
44906-3802
US

IV. Provider business mailing address

715 RICHLAND MALL
ONTARIO OH
44906-3802
US

V. Phone/Fax

Practice location:
  • Phone: 419-709-8650
  • Fax:
Mailing address:
  • Phone: 419-709-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.020129
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.020129
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: