Provider Demographics
NPI:1407828395
Name:MILLER, BRENDA K (APN RNC NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:APN RNC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 N SUMMIT BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 NE JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3843
Practice Address - Country:US
Practice Address - Phone:309-673-0907
Practice Address - Fax:309-673-6914
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001737363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209001737OtherAPN LICENSE
IL041289753OtherRN LICENSE
IL041289753OtherRN LICENSE