Healthcare Provider Details

I. General information

NPI: 1275377715
Provider Name (Legal Business Name): DYLAN MILLER DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 14TH AVE UNIT 4
SEATTLE WA
98122-4064
US

IV. Provider business mailing address

1620 14TH AVE UNIT 4
SEATTLE WA
98122-4064
US

V. Phone/Fax

Practice location:
  • Phone: 360-775-6157
  • Fax:
Mailing address:
  • Phone: 360-775-6157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61599244
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61206990
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: