| Doctor Name: | LORETTA MILLER |
| NPI Number: | 1558747683 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 67975739 |
| Business Practice Address: | 317 Bortot Dr Gallup, NM - 873014779 |
| Business Phone Number: | 5057220023 |
| Business Fax Number: | 5057226977 |
| Mailing Address: | Po Box 3175, GALLUP |
| State: | NM |
| Postal Code: | 873053175 |
| Phone Number: | 5057220023 |
| Fax Number: | 5057226977 |
| NPI Enumeration Date: | 07/30/2015 |
| NPI Last Update Date: | 07/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 67975739 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |