MEDICARE: AYANNA MILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0000X	Wound Care Registered Nurse	22 562514	NY

General Provider Information

NPI Number	:	1255609384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYANNA MILES

Provider Business Mailing Address
First Line	:	8 PEMBROOKE CT
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5013
Country	:	US
Telephone Number	:	516-851-6684
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 PEMBROOKE CT
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5013
Country	:	US
Telephone Number	:	516-851-6684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2011
Last Update Date	:	12/04/2011

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Directions to “ AYANNA MILES ” Practice Location

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