Healthcare Provider Details

I. General information

NPI: 1629374509
Provider Name (Legal Business Name): JUDI R MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33240 N 45TH PL
CAVE CREEK AZ
85331-5073
US

IV. Provider business mailing address

33240 N 45TH PL
CAVE CREEK AZ
85331-5073
US

V. Phone/Fax

Practice location:
  • Phone: 516-509-6320
  • Fax:
Mailing address:
  • Phone: 516-509-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP5099
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number259900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: