Provider Demographics
NPI:1104267418
Name:MILLER, BONNIE JO
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 DEER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAXONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16056-2411
Mailing Address - Country:US
Mailing Address - Phone:724-612-3176
Mailing Address - Fax:
Practice Address - Street 1:521 DEER CREEK RD
Practice Address - Street 2:
Practice Address - City:SAXONBURG
Practice Address - State:PA
Practice Address - Zip Code:16056-2411
Practice Address - Country:US
Practice Address - Phone:724-612-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005623M363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health