Healthcare Provider Details

I. General information

NPI: 1407211568
Provider Name (Legal Business Name): COURTNEY MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 W JOURDAN ST
NEWTON IL
62448-1059
US

IV. Provider business mailing address

1106 N MERCHANT ST P.O. BOX 665
EFFINGHAM IL
62401-2128
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-3800
  • Fax: 618-783-5070
Mailing address:
  • Phone: 217-342-7000
  • Fax: 217-342-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013689
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: