Provider Demographics
NPI:1124334271
Name:MILLER, BRENDA HARLAN (PA-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:HARLAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 MOREWOOD AVE
Mailing Address - Street 2:CMU HEALTH SERVICES
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3814
Mailing Address - Country:US
Mailing Address - Phone:412-268-2157
Mailing Address - Fax:412-268-6357
Practice Address - Street 1:1060 MOREWOOD AVE
Practice Address - Street 2:CMU HEALTH SERVICES
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3814
Practice Address - Country:US
Practice Address - Phone:412-268-2157
Practice Address - Fax:412-268-6357
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000401-L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA000401-LOtherSTATE MEDICAL LISENCE NUMBER