Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 34774 | IA |
NPI | 1255306932 |
---|---|
Provider Name | Dr. Celeste Eileen Miller |
First Address | Davenport, IA 52807-3171 |
Second Address | Davenport, IA 52807-3171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 26/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G20720 | (02) | IL |