Provider Demographics
NPI:1104330026
Name:MILLER, LUCILLE ANNE (RN, MSN, APN-C)
Entity type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, MSN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LIBERTY PL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5708
Mailing Address - Country:US
Mailing Address - Phone:856-318-7537
Mailing Address - Fax:856-762-0774
Practice Address - Street 1:1100 LIBERTY PL UNIT 2
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5708
Practice Address - Country:US
Practice Address - Phone:856-318-7537
Practice Address - Fax:856-516-4494
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N00777500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104330026OtherNPI