MEDICARE: MRS. MELANNIE MICHELLE MILLER LPN

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	164W00000X	Licensed Practical Nurse	PN00842	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PN00482	OTHER	MO	NURSING LICENSE

General Provider Information

NPI Number	:	1366524118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANNIE MICHELLE MILLER LPN

Provider Business Mailing Address
First Line	:	245 SE FLORENCE AVE
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64063-2843
Country	:	US
Telephone Number	:	816-289-4817
Fax Number	:	816-843-3668

Provider Business Practice Location Address
First Line	:	15431 ANDREWS RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64147-1221
Country	:	US
Telephone Number	:	816-843-3677
Fax Number	:	816-843-3668

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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