Provider Demographics
NPI:1821234931
Name:MILLER, NANCY LOUISE (CNM, PA-C)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LOUISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNM, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MIDLINE RD
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-5625
Mailing Address - Country:US
Mailing Address - Phone:607-539-7733
Mailing Address - Fax:
Practice Address - Street 1:314 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5432
Practice Address - Country:US
Practice Address - Phone:607-273-1513
Practice Address - Fax:607-273-8776
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000477367A00000X
NY002047-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant