Healthcare Provider Details

I. General information

NPI: 1104330026
Provider Name (Legal Business Name): LUCILLE ANNE MILLER RN, MSN, APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LIBERTY PL UNIT 2
SICKLERVILLE NJ
08081-5708
US

IV. Provider business mailing address

1100 LIBERTY PL UNIT 2
SICKLERVILLE NJ
08081-5708
US

V. Phone/Fax

Practice location:
  • Phone: 856-318-7537
  • Fax: 856-516-4494
Mailing address:
  • Phone: 856-318-7537
  • Fax: 856-762-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26N00777500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: