Provider Demographics
NPI:1730482464
Name:MILLER, NOAH J (CRNP)
Entity Type:Individual
Prefix:MR
First Name:NOAH
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4201 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3305
Mailing Address - Country:US
Mailing Address - Phone:410-764-8560
Mailing Address - Fax:
Practice Address - Street 1:7207 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2684
Practice Address - Country:US
Practice Address - Phone:410-768-0123
Practice Address - Fax:410-768-1716
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169251363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health