Healthcare Provider Details

I. General information

NPI: 1205748084
Provider Name (Legal Business Name): MELANIE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

16712 TIMBERVIEW DR
CLINTON TWP MI
48036-1666
US

V. Phone/Fax

Practice location:
  • Phone: 586-231-5748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4704201984
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: