Provider Demographics
NPI:1720793110
Name:MILLER, NICHOLAS JAMES
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SHERBROOK STREET, WPG MB
Mailing Address - Street 2:RR 145 REHAB HOSPITAL
Mailing Address - City:WINNIPEG
Mailing Address - State:MANITOBA
Mailing Address - Zip Code:R3A 1M4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 SHERBROOK STREET
Practice Address - Street 2:RR 145 REHAB HOSPITAL
Practice Address - City:WINNIPEG
Practice Address - State:MANITOBA
Practice Address - Zip Code:R3G 1K2
Practice Address - Country:CA
Practice Address - Phone:204-787-7693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-011742081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine