Provider Demographics
NPI:1477752392
Name:MILLER, VIRGINIA LEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:VIRGINIA
Other - Middle Name:LEE
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:1431 MCHENRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4534
Practice Address - Country:US
Practice Address - Phone:209-579-2300
Practice Address - Fax:209-579-1948
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6310363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology