Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 2467 | ND |
NPI | 1003132218 |
---|---|
Provider Name | Ms. Marlene Faye Miller |
First Address | Fort Myers, FL 33912-1973 |
Second Address | Fort Myers, FL 33912-1973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2010 |
Last Update Date | 13/04/2010 |