Provider Demographics
NPI:1194134858
Name:MILLER, SUSAN MARIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:LONEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 LONE OAK CIR
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-5001
Mailing Address - Country:US
Mailing Address - Phone:918-478-2101
Mailing Address - Fax:918-478-6008
Practice Address - Street 1:104 LONE OAK CIR
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434-5001
Practice Address - Country:US
Practice Address - Phone:918-478-2101
Practice Address - Fax:918-478-6008
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK115364363LP2300X
MN2223283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care