Provider Demographics
NPI:1376038018
Name:MILLER, CHANTAE M (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHANTAE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 BAUER DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4847
Mailing Address - Country:US
Mailing Address - Phone:402-613-3371
Mailing Address - Fax:
Practice Address - Street 1:5023 BAUER DR
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4847
Practice Address - Country:US
Practice Address - Phone:402-613-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily