Provider Demographics
NPI:1891803177
Name:MILLER, KRISTINE ELISABETH (ACNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ELISABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 WINTON RD S STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4011
Mailing Address - Country:US
Mailing Address - Phone:585-276-0830
Mailing Address - Fax:
Practice Address - Street 1:1700 PENFIELD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2108
Practice Address - Country:US
Practice Address - Phone:585-426-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430087363L00000X
NYF430087-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891803177Medicare UPIN