Provider Demographics
NPI:1659635167
Name:MILLER, STEPHANIE SELENA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SELENA
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1287
Mailing Address - Country:US
Mailing Address - Phone:304-530-5980
Mailing Address - Fax:304-530-5981
Practice Address - Street 1:206 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1287
Practice Address - Country:US
Practice Address - Phone:304-530-5980
Practice Address - Fax:304-530-5981
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily