Provider Demographics
NPI:1851716054
Name:MILLER, LUCY (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 2ND AVE
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1127
Mailing Address - Country:US
Mailing Address - Phone:781-487-6100
Mailing Address - Fax:
Practice Address - Street 1:52 2ND AVE
Practice Address - Street 2:SUITE 1110
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1127
Practice Address - Country:US
Practice Address - Phone:781-487-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278774363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care