Provider Demographics
NPI:1346221298
Name:MILLER WILKINS, CINDERELLA ANN (PA)
Entity type:Individual
Prefix:
First Name:CINDERELLA
Middle Name:ANN
Last Name:MILLER WILKINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 TIREMAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2712
Mailing Address - Country:US
Mailing Address - Phone:313-418-6666
Mailing Address - Fax:
Practice Address - Street 1:1649 S HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9701
Practice Address - Country:US
Practice Address - Phone:734-480-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004210363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical