Provider Demographics
NPI:1598088965
Name:MILLER, REBECCA YVONNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:YVONNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 CUSHING DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-6430
Mailing Address - Country:US
Mailing Address - Phone:970-593-1064
Mailing Address - Fax:
Practice Address - Street 1:2144 MAIN ST
Practice Address - Street 2:#8
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8402
Practice Address - Country:US
Practice Address - Phone:720-494-1740
Practice Address - Fax:303-772-0042
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA2351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant