MEDICARE: ANDREA SUE MILLER 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	363LF0000X	Family Nurse Practitioner	4704255922	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704255922	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629418041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SUE MILLER N.P.

Provider Business Mailing Address
First Line	:	4211 OKEMOS RD STE 12
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-3287
Country	:	US
Telephone Number	:
Fax Number	:	517-201-0607

Provider Business Practice Location Address
First Line	:	4211 OKEMOS RD STE 12
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-3287
Country	:	US
Telephone Number	:	517-214-9779
Fax Number	:	517-201-0607

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

Provider Enumeration Date	:	06/29/2013
Last Update Date	:	11/22/2025

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