1164735023 NPI number — NAOMI CELESTE MILLER LAC, MAOM

Table of content: NAOMI CELESTE MILLER LAC, MAOM (NPI 1164735023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164735023 NPI number — NAOMI CELESTE MILLER LAC, MAOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
NAOMI
Provider Middle Name:
CELESTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LAC, MAOM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164735023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 RATCLIFF DR. SE
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-729-8358
Provider Business Mailing Address Fax Number:
971-559-5562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 RATCLIFF DR. SE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-881-8361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC152574 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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