Provider Demographics
NPI:1316156672
Name:MILLER, AMY A (A P R N)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:A P R N
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 1565
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-1565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 WINDLEA DR
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:VT
Practice Address - Zip Code:05602-8876
Practice Address - Country:US
Practice Address - Phone:802-249-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0023883364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP1603Medicaid
VT48077OtherBULECROSS BLUESHIELD VT
VTNP1603Medicare ID - Type Unspecified