Provider Demographics
NPI:1508896010
Name:MILLER, JENNIFER LEWIS (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEWIS
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-938-9601
Practice Address - Street 1:1790 OLD TRAIL RD
Practice Address - Street 2:
Practice Address - City:ETTERS
Practice Address - State:PA
Practice Address - Zip Code:17319-9652
Practice Address - Country:US
Practice Address - Phone:717-938-6588
Practice Address - Fax:717-938-9601
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004221B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1551675OtherGATEWAY-WMG
MD618687OtherCAREFIRST MD BCBS
PA03121501OtherCAPITAL BLUE CROSS-WMG
PA1975308OtherHIGHMARK BLUE SHIELD
PA104978OtherJOHNS HOPKINS
PA20019454OtherAMERIHEALTH MERCY-WMG
PA50083185OtherCAPITAL BLUE CROSS-WMG WFM
PA500020830Medicare PIN
PA20019454OtherAMERIHEALTH MERCY-WMG
PA021839FLTMedicare PIN