Provider Demographics
NPI:1023698628
Name:MILLER, ANGELA MARIE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11562 S HICKORY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5453
Mailing Address - Country:US
Mailing Address - Phone:435-901-1995
Mailing Address - Fax:
Practice Address - Street 1:11562 S HICKORY VALLEY DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-5453
Practice Address - Country:US
Practice Address - Phone:435-901-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT91334455-3102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner