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General NPI Number Information
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NPI Number | 1043659196
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Entity Type | Individual
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Provider Name | CHELSEA MILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 4664 N PENNGROVE WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-7442
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Country | US
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Telephone | 208-452-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 NW 16TH ST SUITE 100
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City | FRUITLAND
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State | ID
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Zip | 83619-2271
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Country | US
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Telephone | 208-452-5999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-1012
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License Number State | ID
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