Provider Demographics
NPI:1801163563
Name:MILLER, MARSHA REQUITA (APRN)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:REQUITA
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4654
Mailing Address - Country:US
Mailing Address - Phone:870-862-2331
Mailing Address - Fax:870-862-2322
Practice Address - Street 1:701 N WEST AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4654
Practice Address - Country:US
Practice Address - Phone:870-862-2331
Practice Address - Fax:870-862-2322
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03608363L00000X
ARA003608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner