Healthcare Provider Details

I. General information

NPI: 1558513150
Provider Name (Legal Business Name): MELISSA MARIE MILLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7709 BRUNFIELD DR
BLACKLICK OH
43004-9040
US

IV. Provider business mailing address

7709 BRUNFIELD DR
BLACKLICK OH
43004-9040
US

V. Phone/Fax

Practice location:
  • Phone: 614-937-8125
  • Fax:
Mailing address:
  • Phone: 614-937-8125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number022923
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number327060
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: