Healthcare Provider Details

I. General information

NPI: 1750413696
Provider Name (Legal Business Name): PATRICIA ANN MILLER CNS, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 FULTON DR. NW
CANTON OH
44718
US

IV. Provider business mailing address

681 FRANK BLVD
AKRON OH
44320-1019
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-6075
  • Fax: 330-494-0299
Mailing address:
  • Phone: 330-836-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA05833NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCOA10342NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: