MEDICARE: MARSHA REQUITA MILLER APRN

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	363L00000X	Nurse Practitioner	A03608	AR
2	363LF0000X	Family Nurse Practitioner	A003608	AR

General Provider Information

NPI Number	:	1801163563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA REQUITA MILLER APRN

Provider Business Mailing Address
First Line	:	701 N WEST AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4654
Country	:	US
Telephone Number	:	870-862-2331
Fax Number	:	870-862-2322

Provider Business Practice Location Address
First Line	:	701 N WEST AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4654
Country	:	US
Telephone Number	:	870-862-2331
Fax Number	:	870-862-2322

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	02/22/2017

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