Provider Demographics
NPI:1154608198
Name:MILLER, TERESA MARIE (CNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 BRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-3218
Mailing Address - Country:US
Mailing Address - Phone:614-274-8885
Mailing Address - Fax:614-274-8895
Practice Address - Street 1:2350 BRIGGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-3218
Practice Address - Country:US
Practice Address - Phone:614-274-8885
Practice Address - Fax:614-274-8895
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211062363LF0000X
OHCOA.12878-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00640442Medicaid
OHH057241Medicare PIN
OHH057240Medicare PIN