Provider Demographics
NPI:1790234854
Name:MILLER, AMY L (CRNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
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 1:1000 WATERDAM PLAZA DR STE 240
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5427
Mailing Address - Country:US
Mailing Address - Phone:724-941-2018
Mailing Address - Fax:724-941-2093
Practice Address - Street 1:1000 WATERDAM PLAZA DR STE 240
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5427
Practice Address - Country:US
Practice Address - Phone:724-941-2018
Practice Address - Fax:724-941-2093
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103276150Medicaid