Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 002607 | MO |
NPI | 1104923127 |
---|---|
Provider Name | Dr. Beverly Jean Miles |
First Address | Columbia, MO 65203-4827 |
Second Address | Columbia, MO 65203-4827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |