Healthcare Provider Details

I. General information

NPI: 1043903743
Provider Name (Legal Business Name): SHAWN MILLER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GATEWAY DR
REEDSVILLE PA
17084-9641
US

IV. Provider business mailing address

10 GATEWAY DR
REEDSVILLE PA
17084-9641
US

V. Phone/Fax

Practice location:
  • Phone: 717-363-9310
  • Fax:
Mailing address:
  • Phone: 717-363-9310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF05230904
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: