Provider Demographics
NPI:1679580161
Name:MILLER, CYNTHIA JEAN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W STEWART AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3600
Mailing Address - Country:US
Mailing Address - Phone:541-772-5992
Mailing Address - Fax:541-772-5996
Practice Address - Street 1:255 W STEWART AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3600
Practice Address - Country:US
Practice Address - Phone:541-772-5992
Practice Address - Fax:541-772-5996
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR076036903RN363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS87657Medicare UPIN