Healthcare Provider Details

I. General information

NPI: 1760254585
Provider Name (Legal Business Name): DANIELLE MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N KING STREET
SHEPHERDSTOWN WV
25443
US

IV. Provider business mailing address

413 CHESTERFIELD DR
FALLING WATERS WV
25419-5049
US

V. Phone/Fax

Practice location:
  • Phone: 304-876-5000
  • Fax:
Mailing address:
  • Phone: 301-992-9433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number115650
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: