Provider Demographics
NPI:1912197112
Name:MILLER, COURTNEY A (NP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:A
Other - Last Name:DEMETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1101 SAM PERRY BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4467
Mailing Address - Country:US
Mailing Address - Phone:540-940-2000
Mailing Address - Fax:540-940-2001
Practice Address - Street 1:1101 SAM PERRY BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4467
Practice Address - Country:US
Practice Address - Phone:540-940-2000
Practice Address - Fax:540-940-2001
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007822363LX0001X
VA0024170740363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209007822OtherIL LICENSE
IL209007822OtherIL LICENSE