Provider Demographics
NPI:1518127851
Name:MILLER, JENNIFER K (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4855 S MOORLAND RD FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7494
Mailing Address - Country:US
Mailing Address - Phone:414-425-5660
Mailing Address - Fax:414-425-9803
Practice Address - Street 1:4855 S MOORLAND RD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7494
Practice Address - Country:US
Practice Address - Phone:414-425-5660
Practice Address - Fax:414-425-9803
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1387-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant