Healthcare Provider Details

I. General information

NPI: 1396158408
Provider Name (Legal Business Name): EMILY MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 E SOUTHERN AVE
TEMPE AZ
85282-7649
US

IV. Provider business mailing address

PO BOX 511250
LOS ANGELES CA
90051-7805
US

V. Phone/Fax

Practice location:
  • Phone: 623-624-8280
  • Fax: 602-835-0192
Mailing address:
  • Phone: 510-929-1400
  • Fax: 510-929-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP5619
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP5619
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: