Provider Demographics
NPI:1427419183
Name:MILLER, STACY (CNP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W HIGH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5901
Mailing Address - Country:US
Mailing Address - Phone:419-228-8950
Mailing Address - Fax:419-224-7904
Practice Address - Street 1:770 W HIGH ST STE 350
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5901
Practice Address - Country:US
Practice Address - Phone:419-228-8950
Practice Address - Fax:419-224-7904
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18715-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner