Provider Demographics
NPI:1265133821
Name:MILLER, MORGAN ANNE-MARIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:ANNE-MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:GOFORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26762 E COUNTY HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-8329
Mailing Address - Country:US
Mailing Address - Phone:309-224-6617
Mailing Address - Fax:
Practice Address - Street 1:2426 W CORNERSTONE CT STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2400
Practice Address - Country:US
Practice Address - Phone:309-966-3137
Practice Address - Fax:309-966-3139
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily