MEDICARE: ANGELA DAWN MILLER CFNP

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	45787	WV
2	363LF0000X	Family Nurse Practitioner	NP07364	OH

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649273137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DAWN MILLER CFNP

Provider Business Mailing Address
First Line	:	611 2ND ST
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-2123
Country	:	US
Telephone Number	:	740-373-8756
Fax Number	:	740-373-0091

Provider Business Practice Location Address
First Line	:	611 2ND ST
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-2123
Country	:	US
Telephone Number	:	740-373-8756
Fax Number	:	740-373-0091

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/13/2023

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