Provider Demographics
NPI:1124140033
Name:MILLER, JOANNE MARIE (PHD, APN, CNP)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD, APN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1014
Mailing Address - Country:US
Mailing Address - Phone:312-942-7219
Mailing Address - Fax:312-942-2549
Practice Address - Street 1:600 S PAULINA ST
Practice Address - Street 2:SUITE 1080
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3806
Practice Address - Country:US
Practice Address - Phone:312-942-7219
Practice Address - Fax:312-942-2549
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology