Healthcare Provider Details

I. General information

NPI: 1760731921
Provider Name (Legal Business Name): AMELIA G MILLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MOUNTAIN VIEW RD STE 3
MOSCOW ID
83843-9205
US

IV. Provider business mailing address

505 S MOUNTAIN VIEW RD STE 3
MOSCOW ID
83843-9205
US

V. Phone/Fax

Practice location:
  • Phone: 208-301-7896
  • Fax: 208-883-4404
Mailing address:
  • Phone: 208-301-7896
  • Fax: 208-883-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA60800394
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberPA-2165
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: