Provider Demographics
NPI:1972532463
Name:MILLER, PAMELA S (CNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 SOUTH BURDICK
Mailing Address - Street 2:SUITE 256
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-8585
Mailing Address - Fax:269-341-7518
Practice Address - Street 1:353 SOUTH BURDICK
Practice Address - Street 2:SUITE 256
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8585
Practice Address - Fax:269-341-7518
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704126109363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4837085Medicaid