Provider Demographics
NPI:1841228681
Name:MILLER, AMY J (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-417-7111
Mailing Address - Fax:360-417-7342
Practice Address - Street 1:303 W 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-5904
Practice Address - Country:US
Practice Address - Phone:360-565-0999
Practice Address - Fax:360-457-4841
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60325046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52475816Medicaid
P97914Medicare UPIN
CO52475816Medicaid