Healthcare Provider Details

I. General information

NPI: 1285690222
Provider Name (Legal Business Name): BERTHA TAYLOR-MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BONNIE BROOK RD
ABERDEEN NC
28315
US

IV. Provider business mailing address

211 BONNIE BROOK RD
ABERDEEN NC
28315-3125
US

V. Phone/Fax

Practice location:
  • Phone: 910-716-0099
  • Fax: 910-405-1359
Mailing address:
  • Phone: 910-716-0099
  • Fax: 910-405-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201746
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: