Healthcare Provider Details

I. General information

NPI: 1225044456
Provider Name (Legal Business Name): TERRI MILLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21610 PACIFIC HWY
OCEAN PARK WA
98640
US

IV. Provider business mailing address

1057 12TH AVE
LONGVIEW WA
98632-2509
US

V. Phone/Fax

Practice location:
  • Phone: 360-665-3000
  • Fax: 360-665-3096
Mailing address:
  • Phone: 360-636-3892
  • Fax: 360-414-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN00144640
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP300006182
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: