Provider Demographics
NPI:1659479905
Name:MILLER, ANN RONNA (ANP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:RONNA
Last Name:MILLER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUMMIT DR
Mailing Address - Street 2:APT. 209
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-4000
Mailing Address - Country:US
Mailing Address - Phone:781-944-2873
Mailing Address - Fax:
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5306
Practice Address - Country:US
Practice Address - Phone:617-732-2695
Practice Address - Fax:167-732-2697
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA109754363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1786OtherBCBS
MAMINP1786Medicaid
MANP1786OtherBCBS