Provider Demographics
NPI:1235251034
Name:MILLER, VON L (PA-C)
Entity Type:Individual
Prefix:
First Name:VON
Middle Name:L
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8618 SE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:RUNNELLS
Mailing Address - State:IA
Mailing Address - Zip Code:50237-2178
Mailing Address - Country:US
Mailing Address - Phone:515-250-8935
Mailing Address - Fax:515-241-2040
Practice Address - Street 1:6000 UNIVERSITY AVE LAKEVIEW MEDICAL PARK
Practice Address - Street 2:SUITE 124
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-241-2020
Practice Address - Fax:515-241-2040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001404363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical