Basic Information
| Provider Information | |||||||||
| NPI: | 1821650193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | LEJEANA | ||||||||
| MiddleName: | MARIDECAROL | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3103 DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450151653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138924673 | ||||||||
| FaxNumber: | 5137378197 | ||||||||
| Practice Location | |||||||||
| Address1: | 6570 SOSNA DR | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450142222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139424673 | ||||||||
| FaxNumber: | 5138601439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2019 | ||||||||
| LastUpdateDate: | 09/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.317709 | OH | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 0029179 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | APRN.CNP.0029179 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.