Healthcare Provider Details

I. General information

NPI: 1629733787
Provider Name (Legal Business Name): MICHELLE RENEE MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 DERR RD
SPRINGFIELD OH
45503-2445
US

IV. Provider business mailing address

6480 ROCKSIDE WOODS BLVD S STE 330
INDEPENDENCE OH
44131-2222
US

V. Phone/Fax

Practice location:
  • Phone: 937-390-0005
  • Fax:
Mailing address:
  • Phone: 937-329-9358
  • Fax: 216-238-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0027780
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: