Healthcare Provider Details

I. General information

NPI: 1386873982
Provider Name (Legal Business Name): HEIDI A MILLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 WESTGATE
PENDLETON OR
97801
US

IV. Provider business mailing address

2429 SW PERKINS AVE
PENDLETON OR
97801-4301
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-0802
  • Fax:
Mailing address:
  • Phone: 541-278-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200550105NP FNP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: