Provider Demographics
NPI:1629887021
Name:MILLER, CARRIE LEE (RN, NBC-HWC)
Entity type:Individual
Prefix:
First Name:CARRIE LEE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72487
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97475-0249
Mailing Address - Country:US
Mailing Address - Phone:907-957-5436
Mailing Address - Fax:
Practice Address - Street 1:2978 V ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7949
Practice Address - Country:US
Practice Address - Phone:907-957-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202205953RN163W00000X
A-3850525171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163W00000XNursing Service ProvidersRegistered Nurse