Provider Demographics
NPI:1154860765
Name:MILLER, ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 E SHOW LOW LAKE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7955
Mailing Address - Country:US
Mailing Address - Phone:928-532-6900
Mailing Address - Fax:285-329-6019
Practice Address - Street 1:2650 E SHOW LOW LAKE RD STE 1
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7955
Practice Address - Country:US
Practice Address - Phone:928-537-4300
Practice Address - Fax:928-537-4320
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY32542.1595363LF0000X
AZAP10893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily