Provider Demographics
NPI:1558085688
Name:MILLER, STEPHANIE MARIE (AGPCNP-BC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:
Credentials:AGPCNP-BC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:729 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:MI
Mailing Address - Zip Code:49028-9711
Mailing Address - Country:US
Mailing Address - Phone:309-678-9700
Mailing Address - Fax:
Practice Address - Street 1:3432 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9354
Practice Address - Country:US
Practice Address - Phone:877-279-5960
Practice Address - Fax:877-384-3106
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704313625163WP0808X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health