Provider Demographics
NPI:1003399361
Name:HARRIS-MILLER, MICHELLE ANNETTE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNETTE
Last Name:HARRIS-MILLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5753
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-5753
Mailing Address - Country:US
Mailing Address - Phone:510-393-6748
Mailing Address - Fax:
Practice Address - Street 1:3025 HIGH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1807
Practice Address - Country:US
Practice Address - Phone:510-261-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily