Healthcare Provider Details

I. General information

NPI: 1548664881
Provider Name (Legal Business Name): MELISSA WINGARD MILLER C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE MEDICAL ARTS BUILDING, SUITE 101
DU BOIS PA
15801-1462
US

IV. Provider business mailing address

145 HOSPITAL AVE MEDICAL ARTS BUILDING, SUITE 101
DU BOIS PA
15801-1462
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-4089
  • Fax: 814-375-4967
Mailing address:
  • Phone: 814-375-4089
  • Fax: 814-375-4967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP014319
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: