MEDICARE: MICHELLE L MILLER C.P.N.P.

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	363LP0200X	Pediatric Nurse Practitioner	NP-09050	OH

General Provider Information

NPI Number	:	1356538953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE L MILLER C.P.N.P.

Provider Business Mailing Address
First Line	:	4405 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 102
City	:	TOLEDO
State	:	OH
Zip	:	43623-3529
Country	:	US
Telephone Number	:	419-841-0772
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 102
City	:	TOLEDO
State	:	OH
Zip	:	43623-3529
Country	:	US
Telephone Number	:	419-841-0772
Fax Number	:

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

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	09/27/2007

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