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General NPI Number Information
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NPI Number | 1316134992
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Entity Type | Individual
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Provider Name | MILES EDWARD EVERETT R.D., R.N.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 80 PHOENIX AVE
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City | WATERBURY
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State | CT
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Zip | 06702-1418
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Country | US
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Telephone | 203-756-8021
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Fax |
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Provider Business Mailing Address
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Address Line | 561 HICKORY HILL RD
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City | THOMASTON
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State | CT
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Zip | 06787-1022
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Country | US
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Telephone | 347-406-4714
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Fax |
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 000825
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 082032
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License Number State | CT
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