Healthcare Provider Details

I. General information

NPI: 1003853854
Provider Name (Legal Business Name): JULIANA MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SOUTH MAIN STREET UNIT A
MEDFORD NJ
08055-2371
US

IV. Provider business mailing address

60 S MAIN ST UNIT A
MEDFORD NJ
08055-2431
US

V. Phone/Fax

Practice location:
  • Phone: 609-536-9890
  • Fax:
Mailing address:
  • Phone: 609-536-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00099700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: