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General NPI Number Information
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NPI Number | 1881970945
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Entity Type | Individual
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Provider Name | BEVERLY ANN MILLER PRACTICAL NURSE
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Gender | Female
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 810 S 4TH ST
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City | CLINTON
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State | IN
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Zip | 47842-2220
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Country | US
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Telephone | 765-832-1978
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 184
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City | ROSEDALE
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State | IN
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Zip | 47874-0184
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Country | US
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Telephone | 765-832-1978
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 27031347A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 11675
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License Number State | HI
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