MEDICARE: MRS. GRECIA MARIBEL MILLER RDN

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	133V00000X	Registered Dietitian	86155735	CA

General Provider Information

NPI Number	:	1447026752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRECIA MARIBEL MILLER RDN

Provider Business Mailing Address
First Line	:	3804 NEWTON CT
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-1109
Country	:	US
Telephone Number	:	760-879-5223
Fax Number	:

Provider Business Practice Location Address
First Line	:	3804 NEWTON CT
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-1109
Country	:	US
Telephone Number	:	760-879-5223
Fax Number	:

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

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	11/28/2023

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