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General NPI Number Information
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NPI Number | 1114195518
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Entity Type | Individual
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Provider Name | JENNY LYNN MIELE MD
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Gender | Female
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 11 GARVEY PKWY
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City | SAINT CHARLES
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State | MO
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Zip | 63303-5614
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Country | US
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Telephone | 636-441-7280
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Fax | 636-939-9208
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Provider Business Mailing Address
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Address Line | PO BOX 7412031
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City | CHICAGO
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State | IL
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Zip | 60674-2031
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Country | US
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Telephone | 636-441-7280
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Fax | 636-939-9208
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2008009820
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License Number State | MO
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