Provider Demographics
NPI:1457357337
Name:MILLER, RHONDA R (PAC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 DIAMOND STREET PL
Mailing Address - Street 2:
Mailing Address - City:ONAWA
Mailing Address - State:IA
Mailing Address - Zip Code:51040-1554
Mailing Address - Country:US
Mailing Address - Phone:712-423-1525
Mailing Address - Fax:712-423-2528
Practice Address - Street 1:1614 DIAMOND STREET PL
Practice Address - Street 2:
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-1554
Practice Address - Country:US
Practice Address - Phone:712-423-1525
Practice Address - Fax:712-423-2528
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00275161OtherRAILROAD MEDICARE
IAMG0953958OtherDEA
IAP00275161OtherRAILROAD MEDICARE
IAP89793Medicare UPIN
IAI15472Medicare PIN