Healthcare Provider Details

I. General information

NPI: 1407819717
Provider Name (Legal Business Name): NICOLE F MILLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 7TH AVE SUITE 340
WEST READING PA
19611-1410
US

IV. Provider business mailing address

301 S 7TH AVE SUITE 340
WEST READING PA
19611-1410
US

V. Phone/Fax

Practice location:
  • Phone: 610-375-6565
  • Fax: 610-375-2065
Mailing address:
  • Phone: 610-375-6565
  • Fax: 610-375-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP-008294
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: