Healthcare Provider Details

I. General information

NPI: 1023925112
Provider Name (Legal Business Name): NICHOLUS ROBERT MILLER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 CRIMSON WAY
RICHLAND WA
99354-1671
US

IV. Provider business mailing address

3609 MEADOW BEAUTY DR
PASCO WA
99301-9487
US

V. Phone/Fax

Practice location:
  • Phone: 509-372-7250
  • Fax:
Mailing address:
  • Phone: 509-948-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: