Healthcare Provider Details

I. General information

NPI: 1760219075
Provider Name (Legal Business Name): MICHELLE JANETTE MILLER APRN, RN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N MAIN ST
PROVIDENCE RI
02904-5700
US

IV. Provider business mailing address

5 DRAKE DR
RICHMOND RI
02892-1189
US

V. Phone/Fax

Practice location:
  • Phone: 401-648-7172
  • Fax:
Mailing address:
  • Phone: 951-704-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11803243-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95335899
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN82433
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN05323
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: