Provider Demographics
NPI:1710050976
Name:MILLER, JANE CAROL (CRNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:CAROL
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:MAYPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16240-1730
Mailing Address - Country:US
Mailing Address - Phone:814-856-2766
Mailing Address - Fax:724-543-4380
Practice Address - Street 1:100 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 170
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7135
Practice Address - Country:US
Practice Address - Phone:724-548-8591
Practice Address - Fax:724-543-4380
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008331363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ26917Medicare UPIN