Healthcare Provider Details

I. General information

NPI: 1972532463
Provider Name (Legal Business Name): PAMELA S MILLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 SOUTH BURDICK SUITE 256
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

353 SOUTH BURDICK SUITE 256
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-8585
  • Fax: 269-341-7518
Mailing address:
  • Phone: 269-341-8585
  • Fax: 269-341-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704126109
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: