Healthcare Provider Details

I. General information

NPI: 1245293638
Provider Name (Legal Business Name): MARILYN JOYCE MILLER PHD., CRNP, CS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLDG 80, AVE D
PERRY POINT MD
21902
US

IV. Provider business mailing address

1409 VALLEY FORGE WAY
ABINGDON MD
21009-2707
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax:
Mailing address:
  • Phone: 410-538-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR060407
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR060407
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: