Provider Demographics
NPI:1376343780
Name:MILLER, ISAAC GREGORY
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:GREGORY
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 21ST AVENUE PL
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2392
Mailing Address - Country:US
Mailing Address - Phone:904-463-3571
Mailing Address - Fax:
Practice Address - Street 1:4018 21ST AVENUE PL
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2392
Practice Address - Country:US
Practice Address - Phone:904-463-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion