Provider Demographics
NPI:1306916861
Name:MILLER, ROBERT ANDERSON (NP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDERSON
Last Name:MILLER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 992790
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-2790
Mailing Address - Country:US
Mailing Address - Phone:530-246-5788
Mailing Address - Fax:530-241-7838
Practice Address - Street 1:1035 PLACER ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1125
Practice Address - Country:US
Practice Address - Phone:530-246-5788
Practice Address - Fax:530-241-7838
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP2814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S92579Medicare UPIN