Provider Demographics
NPI:1053541573
Name:MILLER, CONSTANCE RENEE (LPN)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:RENEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MARLBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-1409
Mailing Address - Country:US
Mailing Address - Phone:585-436-8562
Mailing Address - Fax:
Practice Address - Street 1:185 MARLBOROUGH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-1409
Practice Address - Country:US
Practice Address - Phone:585-436-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294645-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse