Healthcare Provider Details

I. General information

NPI: 1376745554
Provider Name (Legal Business Name): VICTORIA PATRICIA MILLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

111 BREWSTER STREET MEMORIAL HOSPITAL OF RHODE ISLAND
PAWTUCKET RI
02860
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-7585
  • Fax: 401-444-2019
Mailing address:
  • Phone: 401-729-2000
  • Fax: 401-444-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00068
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: