Healthcare Provider Details

I. General information

NPI: 1124856067
Provider Name (Legal Business Name): MCKENNA NICOLE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 PARKMOOR DR
WESTERVILLE OH
43082-8837
US

IV. Provider business mailing address

147 HAYFIELD DR
DELAWARE OH
43015-4290
US

V. Phone/Fax

Practice location:
  • Phone: 614-519-6001
  • Fax:
Mailing address:
  • Phone: 740-602-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: