Provider Demographics
NPI:1811676646
Name:MILLER, TODD (NP)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 COMBS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-3107
Mailing Address - Country:US
Mailing Address - Phone:814-558-8582
Mailing Address - Fax:
Practice Address - Street 1:2223 W STATE ST STE 120
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1938
Practice Address - Country:US
Practice Address - Phone:716-373-3544
Practice Address - Fax:716-373-3546
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner