Healthcare Provider Details

I. General information

NPI: 1942609532
Provider Name (Legal Business Name): DENISE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E CHESTNUT HILL AVE 2ND FLOOR
PHILADELPHIA PA
19118-2713
US

IV. Provider business mailing address

33 E CHESTNUT HILL AVE 2ND FLOOR
PHILADELPHIA PA
19118-2713
US

V. Phone/Fax

Practice location:
  • Phone: 215-615-5454
  • Fax:
Mailing address:
  • Phone: 215-615-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP014067
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: