Provider Demographics
NPI:1558605774
Name:MILLER, PAULETTE MARIA (ANP MSN ONC)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:MARIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:ANP MSN ONC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:338 JAMESVILLE AVE
Mailing Address - Street 2:APT 4P
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3273
Mailing Address - Country:US
Mailing Address - Phone:315-479-7097
Mailing Address - Fax:
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:ROOM 115
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-470-2782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3028601363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health