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General NPI Number Information
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NPI Number | 1356611594
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Entity Type | Individual
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Provider Name | JESSICA LYNNE MILLER NCMTB
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Gender | Female
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 11150 HURON ST SUITE 212
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City | NORTHGLENN
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State | CO
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Zip | 80234-4379
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Country | US
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Telephone | 303-952-9826
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Fax |
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Provider Business Mailing Address
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Address Line | 2830 CENTER RIDGE DR
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City | BERTHOUD
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State | CO
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Zip | 80513-8480
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Country | US
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Telephone | 610-308-7738
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 605464-11
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License Number State | CO
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