Healthcare Provider Details

I. General information

NPI: 1245961150
Provider Name (Legal Business Name): CHARLI ANN MILLER APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DUBLIN DR
DOVER OH
44622-7805
US

IV. Provider business mailing address

908 SHANESVILLE RD SW
SUGARCREEK OH
44681-7839
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-0753
  • Fax:
Mailing address:
  • Phone: 740-294-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031028
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: