Provider Demographics
NPI:1639179542
Name:MILLER, VIRGINIA L (CNM)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1233
Mailing Address - Country:US
Mailing Address - Phone:413-530-0581
Mailing Address - Fax:413-517-0661
Practice Address - Street 1:74 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1233
Practice Address - Country:US
Practice Address - Phone:413-530-0581
Practice Address - Fax:413-517-0661
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156494367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0373630Medicaid
043202198OtherCBA
043202198OtherCHILDRENS MED PLAN
043202198008OtherTRICARE
48744OtherHEALTHY START
CN0044OtherBCBS OF MA
21220010239OtherBEECH STREET