Provider Demographics
NPI:1285514463
Name:MILLER, JACQUELINE ELISE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELISE
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 1:4635 E CALLE DEL PANTERA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6216
Mailing Address - Country:US
Mailing Address - Phone:520-873-8112
Mailing Address - Fax:
Practice Address - Street 1:1821 WATER ST SW UNIT A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2851
Practice Address - Country:US
Practice Address - Phone:520-873-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61648318-BDC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula