MEDICARE: BRYN MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	COA.18756	OH

General Provider Information

NPI Number	:	1215398466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYN MILLER

Provider Business Mailing Address
First Line	:	4605 DUKE DR
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-9410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9150 S HILLS BLVD STE 100
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-3511
Country	:	US
Telephone Number	:	330-685-6589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2016
Last Update Date	:	08/14/2024

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