Basic Information
| Provider Information | |||||||||
| NPI: | 1114512324 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | CYNDI | ||||||||
| MiddleName: | LOU | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN, ASN, ADN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 471688 HIGHWAY 51 | ||||||||
| Address2: | |||||||||
| City: | STILWELL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749604490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186968826 | ||||||||
| FaxNumber: | 9186968840 | ||||||||
| Practice Location | |||||||||
| Address1: | 82022 S 4739 RD | ||||||||
| Address2: | |||||||||
| City: | STILWELL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749605253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185755991 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2021 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | L0035627 | OK | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.