Provider Demographics
NPI:1639230360
Name:MILLER, PATRICIA (NP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
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 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-2857
Mailing Address - Fax:217-876-2874
Practice Address - Street 1:241 W WEAVER RD
Practice Address - Street 2:SUITE 240
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-9762
Practice Address - Country:US
Practice Address - Phone:217-876-6350
Practice Address - Fax:217-876-6355
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-129386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner