Provider Demographics
NPI:1477241024
Name:MILLER, BRANDI JO (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 HOGAN STREET
Mailing Address - Street 2:
Mailing Address - City:WILLSHIRE
Mailing Address - State:OH
Mailing Address - Zip Code:45898
Mailing Address - Country:US
Mailing Address - Phone:419-203-1652
Mailing Address - Fax:
Practice Address - Street 1:509 HOGAN STREET
Practice Address - Street 2:
Practice Address - City:WILLSHIRE
Practice Address - State:OH
Practice Address - Zip Code:45898
Practice Address - Country:US
Practice Address - Phone:419-203-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.0033581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily