Healthcare Provider Details

I. General information

NPI: 1689979486
Provider Name (Legal Business Name): JACQUELINE NICHOLE MILLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACKIE NICHOLE MILLER CNP

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W SCHROCK RD STE B
WESTERVILLE OH
43081-2874
US

IV. Provider business mailing address

237 W SCHROCK RD STE B
WESTERVILLE OH
43081-2874
US

V. Phone/Fax

Practice location:
  • Phone: 614-891-0005
  • Fax:
Mailing address:
  • Phone: 614-891-0005
  • Fax: 614-890-3614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN285048
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN285048
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021436
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: