Provider Demographics
NPI:1467589432
Name:MILLER, PATRICIA I (RN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:I
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2729
Mailing Address - Country:US
Mailing Address - Phone:303-704-0750
Mailing Address - Fax:
Practice Address - Street 1:2021 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-1687
Practice Address - Country:US
Practice Address - Phone:970-257-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO008905OtherEMPLOYEE # PRIOR TO RETIR