Provider Demographics
NPI:1831826015
Name:MILLER, VANESSA GAIL
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:GAIL
Last Name:MILLER
Suffix:
Gender:F
Credentials:
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 72376
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-2376
Mailing Address - Country:US
Mailing Address - Phone:907-374-0852
Mailing Address - Fax:907-374-0854
Practice Address - Street 1:815 2ND AVE STE 122
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4469
Practice Address - Country:US
Practice Address - Phone:907-374-0852
Practice Address - Fax:907-374-0854
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020921363L00000X
AK193122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner