Healthcare Provider Details

I. General information

NPI: 1700880523
Provider Name (Legal Business Name): KENNETH PETER MILLER PH.D., RN, CFNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MARROWS RD
NEWARK DE
19713-3701
US

IV. Provider business mailing address

943 ALEXANDRIA DR
NEWARK DE
19711-7711
US

V. Phone/Fax

Practice location:
  • Phone: 302-575-1414
  • Fax:
Mailing address:
  • Phone: 302-368-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0000443
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: