Basic Information
| Provider Information | |||||||||
| NPI: | 1164940524 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DANA | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 KELLEE DR | ||||||||
| Address2: | |||||||||
| City: | DOWELLTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370592102 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5736 MANCHESTER HWY | ||||||||
| Address2: | |||||||||
| City: | MORRISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373577503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318153871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2017 | ||||||||
| LastUpdateDate: | 09/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 73987 | TN | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 73987 | 01 | TN | LPN LICENSE | OTHER |