Provider Demographics
NPI:1144403817
Name:MILEY, MONIQUE T (APRN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:T
Last Name:MILEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:T
Other - Last Name:ALLGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1250 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3946
Mailing Address - Country:US
Mailing Address - Phone:860-346-0300
Mailing Address - Fax:
Practice Address - Street 1:1250 SILVER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3946
Practice Address - Country:US
Practice Address - Phone:860-346-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003687363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily