Healthcare Provider Details

I. General information

NPI: 1326507609
Provider Name (Legal Business Name): MRS. DESIRAE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROCK ST
MIDDLETOWN PA
17057-4644
US

IV. Provider business mailing address

10 ROCK ST
MIDDLETOWN PA
17057-4644
US

V. Phone/Fax

Practice location:
  • Phone: 717-380-6866
  • Fax:
Mailing address:
  • Phone: 717-380-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: