Healthcare Provider Details

I. General information

NPI: 1932171329
Provider Name (Legal Business Name): LISA MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/21/2023
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MAIN ST
GREENFIELD MA
01301-3275
US

IV. Provider business mailing address

102 MAIN ST
GREENFIELD MA
01301-3275
US

V. Phone/Fax

Practice location:
  • Phone: 413-325-8500
  • Fax:
Mailing address:
  • Phone: 413-325-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213928
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: