Provider Demographics
NPI:1265591465
Name:MILLER, MELISSA L (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 S ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4113
Mailing Address - Country:US
Mailing Address - Phone:775-329-6300
Mailing Address - Fax:775-348-3896
Practice Address - Street 1:2244 ODDIE BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-7574
Practice Address - Country:US
Practice Address - Phone:775-997-7300
Practice Address - Fax:775-997-7350
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV110117032OtherRR MEDICARE
NV110117032OtherRR MEDICARE
NVF66155Medicare UPIN