Provider Demographics
NPI:1073829487
Name:MILLER, NATHAN LEE (PA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 N INDIANOLA AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9325
Mailing Address - Country:US
Mailing Address - Phone:559-259-6518
Mailing Address - Fax:
Practice Address - Street 1:6057 N 1ST ST
Practice Address - Street 2:SUITE #105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5468
Practice Address - Country:US
Practice Address - Phone:559-436-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21116363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical