Provider Demographics
NPI:1285161430
Name:MILLER, COLLEEN (NP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41400 DEQUINDRE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3751
Mailing Address - Country:US
Mailing Address - Phone:586-843-3815
Mailing Address - Fax:586-843-3920
Practice Address - Street 1:17000 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1263
Practice Address - Country:US
Practice Address - Phone:586-563-5555
Practice Address - Fax:586-563-1778
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704233398363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704233398OtherSTATE OF MICHIGAN