Healthcare Provider Details

I. General information

NPI: 1487734844
Provider Name (Legal Business Name): IRENE B. MILLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 FAIR HARBOUR PL
NEW LONDON CT
06320-4710
US

IV. Provider business mailing address

41 FAIR HARBOUR PL
NEW LONDON CT
06320-4710
US

V. Phone/Fax

Practice location:
  • Phone: 860-437-6914
  • Fax: 860-437-6920
Mailing address:
  • Phone: 860-437-6914
  • Fax: 860-437-6920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberMM0139887
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: