MEDICARE: MS. TRACI RAE MILLER RN, MSN, CRNP

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	363L00000X	Nurse Practitioner	R117726	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659379683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACI RAE MILLER RN, MSN, CRNP

Provider Business Mailing Address
First Line	:	729 PINE TRL
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-1628
Country	:	US
Telephone Number	:	410-340-3842
Fax Number	:

Provider Business Practice Location Address
First Line	:	6095 MARSHALEE DR
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6053
Country	:	US
Telephone Number	:	410-379-3400
Fax Number	:

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	10/02/2008

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