Healthcare Provider Details

I. General information

NPI: 1700074366
Provider Name (Legal Business Name): RACHEL NICOLE MILLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL NICOLE KOTRBA PA-C

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WEEKS DR
ROXBORO NC
27573-3929
US

IV. Provider business mailing address

107 WEEKS DR
ROXBORO NC
27573-3929
US

V. Phone/Fax

Practice location:
  • Phone: 336-598-5480
  • Fax:
Mailing address:
  • Phone: 336-598-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2205-023
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA07301
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-07814
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: