Provider Demographics
NPI:1942916507
Name:MILLER, DESIREE LYNN (RN FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN FNP-BC
Other - Prefix:MS
Other - First Name:DESIREE
Other - Middle Name:LYNN
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1364 E SHOREWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5292
Mailing Address - Country:US
Mailing Address - Phone:231-206-8529
Mailing Address - Fax:
Practice Address - Street 1:1364 E SHOREWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5292
Practice Address - Country:US
Practice Address - Phone:231-206-8529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268609363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily