Healthcare Provider Details

I. General information

NPI: 1669071718
Provider Name (Legal Business Name): DONNA YVONNE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 ROTTWEILER RD.
BRUNO WV
25611
US

IV. Provider business mailing address

PO BOX 262
BRUNO WV
25611-0262
US

V. Phone/Fax

Practice location:
  • Phone: 304-583-0511
  • Fax:
Mailing address:
  • Phone: 304-583-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: