Provider Demographics
NPI:1407153018
Name:MILLER, MARIANNE I (CPNP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:I
Last Name:MILLER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 945
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-563-2132
Mailing Address - Fax:312-563-2131
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 945
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-563-2132
Practice Address - Fax:312-563-2131
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20172363LP0200X
IL209009289363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20172OtherNP LICENSE NUMBER
IL209.009289OtherILLINOIS NP LICENSE NUMBER