Individual
TAKKYLA MONIQUE MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1103 E 11TH ST, ERIE, PA 16503-1607
(814) 528-5962
Mailing address
1103 E 11TH ST, ERIE, PA 16503-1607
(814) 528-5962
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN275719
PA
Other
Enumeration date
06/11/2009
Last updated
06/11/2009
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