Provider Demographics
NPI:1770354508
Name:MILLER, MEGAN KAYE (AGPCNP-BC, BSN, RN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:KAYE
Last Name:MILLER
Suffix:
Gender:F
Credentials:AGPCNP-BC, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:ELEVA
Mailing Address - State:WI
Mailing Address - Zip Code:54738-0360
Mailing Address - Country:US
Mailing Address - Phone:262-421-5133
Mailing Address - Fax:262-735-0723
Practice Address - Street 1:4423 GOLF TER STE 1
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4903
Practice Address - Country:US
Practice Address - Phone:262-421-5133
Practice Address - Fax:262-735-0723
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14914-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology