Individual
REBA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
830 PINEHILL RD, JENA, LA 71342-4137
(318) 992-7608
Mailing address
830 PINEHILL RD, JENA, LA 71342-4137
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20130815
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009083078
DRIVER'S LICENSE
LA
Enumeration date
10/05/2017
Last updated
06/16/2018
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