Provider Demographics
NPI:1992178883
Name:MILLER, LESLI SUZON (APN)
Entity Type:Individual
Prefix:MS
First Name:LESLI
Middle Name:SUZON
Last Name:MILLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:530 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3654
Mailing Address - Country:US
Mailing Address - Phone:732-202-8071
Mailing Address - Fax:732-922-6026
Practice Address - Street 1:130 SPEEDWELL AVE
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2315
Practice Address - Country:US
Practice Address - Phone:862-242-8053
Practice Address - Fax:862-242-8054
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00595300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health