Marietta Camra Miller, LPN
Individual provider Active NPI Licensed Practical Nurse · Basin, WY
NPI 1154853398 · NPPES record last updated Mar 28, 2017
Key facts
- NPI
- 1154853398
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 3362 (WY)
- Practice address
- 617 Zane Ave
Basin, WY 82410 - Phone
- (307) 272-9888
- NPI assigned
- Mar 28, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3362 | WY | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 3362 | WY | Yes |
Addresses
Primary practice location
617 Zane Ave
Basin, WY 82410
Mailing address
617 Zane Ave
Basin, WY 82410
Other providers in Basin, WY
- Darwin L Irvine
- Deborah Collins Jones
- Anja Louis
- Ralph Henry Louis Jr.
- Kara Magid
- Rebecca Myers
- Whitney Jay Neves
- Rosemary Newton
- Julie A Oster
- David Sherwin Peterson
All providers in Basin, WY · Licensed Practical Nurse in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.