Healthcare Provider Details

I. General information

NPI: 1366022311
Provider Name (Legal Business Name): CATHERINE A MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 CEDAR LN
COLUMBIA MD
21044-2999
US

IV. Provider business mailing address

5755 CEDAR LN
COLUMBIA MD
21044-2999
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-7766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberR105633
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: