Provider Demographics
NPI:1235119611
Name:MILLER, PAMELA YVONNE (CRNP, CPNP, FNPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:YVONNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNP, CPNP, FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:33 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-1006
Practice Address - Country:US
Practice Address - Phone:618-445-2287
Practice Address - Fax:618-445-2257
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002592363LF0000X, 363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364131874003Medicaid
ILK06761Medicare UPIN
IL364131874003Medicaid