Provider Demographics
NPI:1689112088
Name:MILLER, JUSTINA M (RN, CNP)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8306
Mailing Address - Country:US
Mailing Address - Phone:330-892-5092
Mailing Address - Fax:330-921-4171
Practice Address - Street 1:116 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8306
Practice Address - Country:US
Practice Address - Phone:330-892-5092
Practice Address - Fax:330-921-4171
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.341413163W00000X
PASP024002363LF0000X
OH020390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse