Provider Demographics
NPI:1659871465
Name:MILLER, JOLONDA ELAINE JR (LPN)
Entity type:Individual
Prefix:
First Name:JOLONDA
Middle Name:ELAINE
Last Name:MILLER
Suffix:JR
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JOLONDA
Other - Middle Name:ELAINE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:10331 SPRINGPOINTE CIRCLE APT B
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10331 SPRINGPOINTE CIR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-0913
Practice Address - Country:US
Practice Address - Phone:937-231-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147636164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid