Healthcare Provider Details

I. General information

NPI: 1538502505
Provider Name (Legal Business Name): CORRIE BETH MILLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 801
HONOLULU HI
96826-1032
US

IV. Provider business mailing address

677 ALA MOANA BLVD STE 1001
HONOLULU HI
96813-5408
US

V. Phone/Fax

Practice location:
  • Phone: 808-203-6580
  • Fax:
Mailing address:
  • Phone: 808-469-4900
  • Fax: 808-587-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDOS-1807
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: