MEDICARE: DR. MARIANNE MILES NP, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	400699	NY

General Provider Information

NPI Number	:	1568577880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANNE MILES NP, PHD

Provider Business Mailing Address
First Line	:	5770 SMITH RD
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-8927
Country	:	US
Telephone Number	:	585-396-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 NORTH ST STE G
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1053
Country	:	US
Telephone Number	:	585-455-0068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	01/10/2023

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