Healthcare Provider Details

I. General information

NPI: 1457819682
Provider Name (Legal Business Name): VERONICA V MILES ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5285 LEWISTON RD
LEWISTON NY
14092-1942
US

IV. Provider business mailing address

PO BOX 7411009
CHICAGO IL
60674-3009
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax: 312-635-0050
Mailing address:
  • Phone: 872-231-3162
  • Fax: 312-635-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: