Provider Demographics
NPI:1669559795
Name:MILLER, CHRISTINA LYNDELL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LYNDELL
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:LYNDELL
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:609-364-7157
Mailing Address - Fax:865-692-5900
Practice Address - Street 1:1500 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2844
Practice Address - Country:US
Practice Address - Phone:828-687-6282
Practice Address - Fax:828-687-6285
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1460363AM0700X
NY020563363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400370502OtherMEDICARE PTAN
Q76345Medicare UPIN