Individual
KELLY MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22223 N 1525 EAST RD, DANVILLE, IL 61834-8200
(217) 260-3672
Mailing address
22223 N 1525 EAST RD, DANVILLE, IL 61834-8200
(217) 260-3672
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043089318
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063434633
—
IL
Enumeration date
11/16/2017
Last updated
11/16/2017
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