Provider Demographics
NPI:1376823476
Name:MILLER, DIANA M (FNP-C)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WHITNEY RD S
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9635
Mailing Address - Country:US
Mailing Address - Phone:518-583-7231
Mailing Address - Fax:
Practice Address - Street 1:125 WOLF RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1221
Practice Address - Country:US
Practice Address - Phone:917-273-5409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3343581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily