Carl Miller

Individual provider Active NPI Licensed Practical Nurse · Stillwater, NY

NPI 1194156711 · NPPES record last updated Dec 7, 2013

Key facts

NPI
1194156711
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
287378 (NY)
Practice address
4 Oak LN
Stillwater, NY 12170-2210
Phone
(518) 796-2096
NPI assigned
Dec 7, 2013
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
287378NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 287378 NY Yes

Addresses

Primary practice location

4 Oak LN
Stillwater, NY 12170-2210

Mailing address

4 Oak LN
Stillwater, NY 12170-2210
Phone (518) 796-2096

Other providers in Stillwater, NY

All providers in Stillwater, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.