Provider Demographics
NPI:1649273137
Name:MILLER, ANGELA DAWN (CFNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:MILLER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2123
Mailing Address - Country:US
Mailing Address - Phone:740-373-8756
Mailing Address - Fax:740-373-0091
Practice Address - Street 1:611 2ND ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2123
Practice Address - Country:US
Practice Address - Phone:740-373-8756
Practice Address - Fax:740-373-0091
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV45787363LF0000X
OHNP07364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2552929Medicaid
WV7103074000Medicaid
WVP39985Medicare UPIN
OHMINP08753Medicare ID - Type UnspecifiedMEDICARE MARIETTA
OHMINP08754Medicare ID - Type UnspecifiedMEDICARE BELPRE