Healthcare Provider Details

I. General information

NPI: 1679580161
Provider Name (Legal Business Name): CYNTHIA JEAN MILLER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W STEWART AVE SUITE 101
MEDFORD OR
97501-3600
US

IV. Provider business mailing address

255 W STEWART AVE SUITE 101
MEDFORD OR
97501-3600
US

V. Phone/Fax

Practice location:
  • Phone: 541-772-5992
  • Fax: 541-772-5996
Mailing address:
  • Phone: 541-772-5992
  • Fax: 541-772-5996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number076036903RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: