Provider Demographics
NPI:1619374816
Name:MILLER, MELISSA KAYE (AGPCNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:KAYE
Last Name:MILLER
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 W STARIN RD
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1121
Mailing Address - Country:US
Mailing Address - Phone:262-472-1300
Mailing Address - Fax:
Practice Address - Street 1:710 W STARIN RD
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1121
Practice Address - Country:US
Practice Address - Phone:262-472-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6110-33363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care