Healthcare Provider Details

I. General information

NPI: 1912197112
Provider Name (Legal Business Name): COURTNEY A MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY A DEMETER RN

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD SUITE 401
FREDERICKSBURG VA
22401-4467
US

IV. Provider business mailing address

2300 FALL HILL AVE STE 317
FREDERICKSBURG VA
22401-3343
US

V. Phone/Fax

Practice location:
  • Phone: 540-940-2000
  • Fax: 540-940-2001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209007822
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024170740
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: