Healthcare Provider Details

I. General information

NPI: 1639664469
Provider Name (Legal Business Name): LEAANNA H MILLER CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 HAWTHORNE AVE
RICHMOND VA
23222
US

IV. Provider business mailing address

3416 HAWTHORNE AVE
RICHMOND VA
23222
US

V. Phone/Fax

Practice location:
  • Phone: 804-855-4438
  • Fax:
Mailing address:
  • Phone: 804-855-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129-000135
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: