Provider Demographics
NPI:1013028232
Name:MILLER, LYNNE MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4211
Mailing Address - Country:US
Mailing Address - Phone:607-723-7818
Mailing Address - Fax:
Practice Address - Street 1:425 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-4101
Practice Address - Country:US
Practice Address - Phone:607-772-9100
Practice Address - Fax:607-772-3081
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332152-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily