Provider Demographics
NPI:1104953686
Name:MILLER, PAMELA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 RURAL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3250
Mailing Address - Country:US
Mailing Address - Phone:570-321-3131
Mailing Address - Fax:570-321-3130
Practice Address - Street 1:699 RURAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3250
Practice Address - Country:US
Practice Address - Phone:570-321-3131
Practice Address - Fax:570-321-3130
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP002082G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007548350033Medicaid