Provider Demographics
NPI:1285770305
Name:MILLER, CONNIE M (FNP-C, CDE, BC-ADM)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-C, CDE, BC-ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:7235 WELD COUNTY ROAD 96
Mailing Address - City:WELLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80549-0685
Mailing Address - Country:US
Mailing Address - Phone:970-897-2945
Mailing Address - Fax:970-897-3052
Practice Address - Street 1:1504 STINSON AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3319
Practice Address - Country:US
Practice Address - Phone:307-632-8064
Practice Address - Fax:307-632-6131
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY20234.0234363LF0000X
CO124523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1229583Medicaid
WY1229583Medicaid
WYS92902Medicare UPIN