Provider Demographics
NPI:1598709453
Name:MILLER, MELINDA SUE (NP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 MAJESTIC OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443
Mailing Address - Country:US
Mailing Address - Phone:330-324-3738
Mailing Address - Fax:
Practice Address - Street 1:241 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:MIDWAY PARK
Practice Address - State:NC
Practice Address - Zip Code:28544-1418
Practice Address - Country:US
Practice Address - Phone:910-353-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07929363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2526949Medicaid
MINP16241Medicare ID - Type Unspecified
OH2526949Medicaid