Provider Demographics
NPI:1225044456
Name:MILLER, TERRI (ARNP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2509
Mailing Address - Country:US
Mailing Address - Phone:360-636-3892
Mailing Address - Fax:360-414-1114
Practice Address - Street 1:21610 PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:OCEAN PARK
Practice Address - State:WA
Practice Address - Zip Code:98640
Practice Address - Country:US
Practice Address - Phone:360-665-3000
Practice Address - Fax:360-665-3096
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00144640163WG0000X
WAAP300006182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9634569Medicaid
WA9634569Medicaid
WAGAB28647Medicare PIN