Provider Demographics
NPI:1598102337
Name:MILLER, BERWIN RALPH JR (CNP)
Entity Type:Individual
Prefix:
First Name:BERWIN
Middle Name:RALPH
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 GROVEPORT RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-1006
Mailing Address - Country:US
Mailing Address - Phone:614-343-4783
Mailing Address - Fax:614-830-2024
Practice Address - Street 1:6011 GROVEPORT ROAD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125
Practice Address - Country:US
Practice Address - Phone:614-343-4783
Practice Address - Fax:614-830-2024
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 15623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily