Provider Demographics
NPI:1407003098
Name:MILLER, JULIE ANN (CNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:LIVELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:716 COMMERCIAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-9367
Mailing Address - Country:US
Mailing Address - Phone:330-343-7605
Mailing Address - Fax:
Practice Address - Street 1:716 COMMERCIAL AVE SW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-9367
Practice Address - Country:US
Practice Address - Phone:330-343-7605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 10439-NP363LF0000X
OHRN 311853164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2917731Medicaid
OHNP29621Medicare PIN