Provider Demographics
NPI:1699009787
Name:MILLER, JACQUELINE MARY (MSN,ANP-C)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARY
Last Name:MILLER
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Gender:F
Credentials:MSN,ANP-C
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Mailing Address - Street 1:245 VINEYARD HAVEN -EDGARTOWN ROAD
Mailing Address - Street 2:P.O BOX 9000
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539
Mailing Address - Country:US
Mailing Address - Phone:508-939-9358
Mailing Address - Fax:508-939-8644
Practice Address - Street 1:245 EDGARTOWN- VINEYARD HAVEN ROAD
Practice Address - Street 2:ISLAND HEALTH CARE
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539
Practice Address - Country:US
Practice Address - Phone:508-939-9358
Practice Address - Fax:508-939-8644
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
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Provider Licenses
StateLicense IDTaxonomies
MA213927363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care