Provider Demographics
NPI:1255356291
Name:MILLER, BENJAMIN J (ARNP)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17207 146TH SEAVE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8700
Mailing Address - Country:US
Mailing Address - Phone:406-550-9256
Mailing Address - Fax:
Practice Address - Street 1:2120 S RESERVE ST # 133
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6451
Practice Address - Country:US
Practice Address - Phone:406-550-9012
Practice Address - Fax:801-772-7767
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006070363L00000X
MTRN26399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9632027Medicaid
WAP16867Medicare UPIN
WA9632027Medicaid