Individual
JACQUELYN PERRY MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
26317 WEST WASHINGTON STREET, BUILDING 66, PETERSBURG, VA 23842
(804) 722-4299
Mailing address
13504 TAYLOR DRIVE, DISPUTANTA, VA 23842
(804) 514-1007
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001186020
VA
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
0001186020
VA
Other
Enumeration date
01/06/2012
Last updated
01/06/2012
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