Provider Demographics
NPI:1407211568
Name:MILLER, COURTNEY (NP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N MERCHANT ST
Mailing Address - Street 2:P.O. BOX 665
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2128
Mailing Address - Country:US
Mailing Address - Phone:217-342-7000
Mailing Address - Fax:217-342-7002
Practice Address - Street 1:1106 N MERCHANT ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2128
Practice Address - Country:US
Practice Address - Phone:217-342-7000
Practice Address - Fax:217-342-7002
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily