Provider Demographics
NPI:1740349430
Name:MILLER, JOANNIE JEANETTE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JOANNIE
Middle Name:JEANETTE
Last Name:MILLER
Suffix:
Gender:
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97449-0298
Mailing Address - Country:US
Mailing Address - Phone:541-419-2645
Mailing Address - Fax:
Practice Address - Street 1:281 W 24TH ST STE 134
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8564
Practice Address - Country:US
Practice Address - Phone:928-919-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250124NP FNP PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00259333OtherRAILROAD MEDICARE
OR000840Medicaid
ORP00259333OtherRAILROAD MEDICARE
OR000840Medicaid