Provider Demographics
NPI:1063895167
Name:MILLER, CARRIE LEE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 SHENANDOAH
Mailing Address - Street 2:
Mailing Address - City:JOHANNESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49751-8732
Mailing Address - Country:US
Mailing Address - Phone:989-858-3329
Mailing Address - Fax:
Practice Address - Street 1:220 W GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1631
Practice Address - Country:US
Practice Address - Phone:989-732-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily