Provider Demographics
NPI:1053732982
Name:MILLER, VENISS
Entity type:Individual
Prefix:
First Name:VENISS
Middle Name:
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 1:3466 BRIDGELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST.LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:314-922-8920
Mailing Address - Fax:314-344-5003
Practice Address - Street 1:3466 BRIDGELAND DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2606
Practice Address - Country:US
Practice Address - Phone:314-922-8920
Practice Address - Fax:314-344-5003
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health