Provider Demographics
NPI:1447421227
Name:MILLER, AGNES I (CHP-C)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:I
Last Name:MILLER
Suffix:
Gender:F
Credentials:CHP-C
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:MEGANACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5530
Mailing Address - Street 2:
Mailing Address - City:PORT GRAHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99603-5530
Mailing Address - Country:US
Mailing Address - Phone:907-284-2241
Mailing Address - Fax:907-284-2277
Practice Address - Street 1:5530 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PORT GRAHAM
Practice Address - State:AK
Practice Address - Zip Code:99603-5530
Practice Address - Country:US
Practice Address - Phone:907-284-2241
Practice Address - Fax:907-284-2277
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker