Healthcare Provider Details

I. General information

NPI: 1366331183
Provider Name (Legal Business Name): CYNTHIA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

IV. Provider business mailing address

PO BOX 214
LUBEC ME
04652-0214
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-3019
  • Fax:
Mailing address:
  • Phone: 352-448-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN2359759
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: