Provider Demographics
NPI:1386795003
Name:MILLERD, MICHELLE (CNM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MILLERD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-2508
Mailing Address - Fax:
Practice Address - Street 1:51 PERFORMANCE DR
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3104
Practice Address - Country:US
Practice Address - Phone:781-682-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0036435OtherNHP
MA8129874OtherCIGNA
MAAA45651OtherHPHC
MA0707473Medicaid
MACN0355OtherBCBS
MA0707473Medicaid
MAS98216Medicare UPIN