Provider Demographics
NPI:1548476088
Name:MILLER, VIRGINIA LUCILLE
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LUCILLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10839 HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45142-9442
Mailing Address - Country:US
Mailing Address - Phone:937-364-6676
Mailing Address - Fax:937-364-6676
Practice Address - Street 1:5613 CONCORD RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-9699
Practice Address - Country:US
Practice Address - Phone:937-393-6936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2262322Medicaid