MEDICARE: REGINA MARIE MILLER CRNP

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	363LG0600X	Gerontology Nurse Practitioner	R131611	MD

General Provider Information

NPI Number	:	1871644039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA MARIE MILLER CRNP

Provider Business Mailing Address
First Line	:	8752 ASPEN GROVE CT
Second Line	:
City	:	ODENTON
State	:	MD
Zip	:	21113-2229
Country	:	US
Telephone Number	:	443-871-1878
Fax Number	:	410-379-3591

Provider Business Practice Location Address
First Line	:	6095 MARSHALEE DR
Second Line	:	EVERCARE 1ST FLOOR
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6053
Country	:	US
Telephone Number	:	410-379-3400
Fax Number	:	410-379-3591

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	08/19/2008

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