Healthcare Provider Details

I. General information

NPI: 1942592035
Provider Name (Legal Business Name): LYNN MARIE MILLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LURAY DR
WINTERSVILLE OH
43953-3973
US

IV. Provider business mailing address

120 LEXINGTON CT
WEIRTON WV
26062-3333
US

V. Phone/Fax

Practice location:
  • Phone: 740-314-8258
  • Fax: 304-723-2195
Mailing address:
  • Phone: 304-374-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number64897
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.13229
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: