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General NPI Number Information
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NPI Number | 1508179235
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Entity Type | Individual
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Provider Name | ANDREA NICHOLE MILLER AT/C, AT/L
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Gender | Female
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 4606 BRIDGEPORT WAY W #C
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4200
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Country | US
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Telephone | 253-565-3551
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Fax | 253-565-4535
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Provider Business Mailing Address
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Address Line | 4606 BRIDGEPORT WAY W #C
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4200
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Country | US
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Telephone | 253-565-3551
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Fax | 253-565-4535
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A1 60066953
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License Number State | WA
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