Provider Demographics
NPI:1154672145
Name:MILLER, MELANIE ROSE (CNM)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ROSE
Last Name:MILLER
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N HAYWORTH AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2881
Mailing Address - Country:US
Mailing Address - Phone:419-290-1499
Mailing Address - Fax:
Practice Address - Street 1:5308 HARROUN RD
Practice Address - Street 2:SUITE 175
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2114
Practice Address - Country:US
Practice Address - Phone:419-824-5608
Practice Address - Fax:419-882-3686
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN302920-COA1163W00000X
OHCOA13801-NM367A00000X
CA236429367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse