Provider Demographics
NPI:1326632357
Name:MILLER, MICHELLE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 MCAULEY DR RM 1000
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1024
Mailing Address - Country:US
Mailing Address - Phone:734-712-7246
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DR RM 1000
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1024
Practice Address - Country:US
Practice Address - Phone:734-712-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPENDING363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704247013OtherREGISTERED NURSE LICENSE