Healthcare Provider Details

I. General information

NPI: 1760637748
Provider Name (Legal Business Name): PAMELA WOODS MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BLACK OAK
MEDFORD OR
97504
US

IV. Provider business mailing address

555 BLACK OAK DR SUITE 100
MEDFORD OR
97504-8447
US

V. Phone/Fax

Practice location:
  • Phone: 541-734-3430
  • Fax:
Mailing address:
  • Phone: 541-734-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200850068NP FNP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: