Provider Demographics
NPI:1104060250
Name:MILLER, KATHLEEN WHALEN (NNP BC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:WHALEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:NNP BC
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:W
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NNP BC (BSN)
Mailing Address - Street 1:8300 W 38TH AVE
Mailing Address - Street 2:NICU
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6005
Mailing Address - Country:US
Mailing Address - Phone:303-425-2217
Mailing Address - Fax:303-425-8667
Practice Address - Street 1:8300 W 38TH AVE
Practice Address - Street 2:NICU
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6005
Practice Address - Country:US
Practice Address - Phone:303-425-2217
Practice Address - Fax:303-425-8667
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49651363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care