Provider Demographics
NPI:1942592035
Name:MILLER, LYNN MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LEXINGTON CT
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3333
Mailing Address - Country:US
Mailing Address - Phone:304-374-0181
Mailing Address - Fax:
Practice Address - Street 1:200 LURAY DR
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3973
Practice Address - Country:US
Practice Address - Phone:740-314-8258
Practice Address - Fax:304-723-2195
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV64897363LF0000X
OHAPRN.CNP.13229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050615Medicaid
WV3810020176Medicaid
OH0050615Medicaid