Provider Demographics
NPI:1639280977
Name:MILLER, MARILYN J (ARNP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9013
Mailing Address - Country:US
Mailing Address - Phone:316-283-4153
Mailing Address - Fax:316-282-0550
Practice Address - Street 1:700 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9013
Practice Address - Country:US
Practice Address - Phone:316-283-4153
Practice Address - Fax:316-282-0550
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45077363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
500014294Medicare PIN
P14666Medicare UPIN
110296Medicare PIN