Provider Demographics
NPI:1043830987
Name:MILLER, CARLA (PHD, RD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 BENS CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1868
Mailing Address - Country:US
Mailing Address - Phone:614-710-1402
Mailing Address - Fax:
Practice Address - Street 1:4520 BENS CT
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1868
Practice Address - Country:US
Practice Address - Phone:614-710-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6217133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered