Healthcare Provider Details

I. General information

NPI: 1811820400
Provider Name (Legal Business Name): HOLLY DEANNA MILLER DNP, APRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01605-2464
US

IV. Provider business mailing address

76 SOUTH ST
NORTHBOROUGH MA
01532-2606
US

V. Phone/Fax

Practice location:
  • Phone: 651-245-9369
  • Fax:
Mailing address:
  • Phone: 651-245-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberE615059717412
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: