Healthcare Provider Details

I. General information

NPI: 1407735913
Provider Name (Legal Business Name): NICOLE ANGELINA MILLISER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ANGELINA NICKOLAS RN

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2658 N COLUMBUS ST
LANCASTER OH
43130-8744
US

IV. Provider business mailing address

2400 DEEDS RD
GRANVILLE OH
43023-9698
US

V. Phone/Fax

Practice location:
  • Phone: 740-277-6269
  • Fax:
Mailing address:
  • Phone: 740-405-0958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042627
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number389356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: