Healthcare Provider Details

I. General information

NPI: 1366473100
Provider Name (Legal Business Name): GINA L MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 MAIN ST
HACKBERRY LA
70645-3303
US

IV. Provider business mailing address

1020 MAIN ST
HACKBERRY LA
70645-3303
US

V. Phone/Fax

Practice location:
  • Phone: 337-788-1081
  • Fax: 337-788-1083
Mailing address:
  • Phone: 337-788-1081
  • Fax: 337-788-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04570
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: