Healthcare Provider Details

I. General information

NPI: 1194913210
Provider Name (Legal Business Name): EILEEN MARY MILLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 WEST MAIN STREET
AVON CT
06001
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HHC CVO ENROLLMENT 1ST FLOOR
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-777-1280
  • Fax:
Mailing address:
  • Phone: 860-972-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF342266-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number007457
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number289585-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: