Provider Demographics
NPI:1912085564
Name:MILLER, CHERYL (NP-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 E HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1127
Mailing Address - Country:US
Mailing Address - Phone:989-345-5240
Mailing Address - Fax:989-345-4513
Practice Address - Street 1:337 E HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1127
Practice Address - Country:US
Practice Address - Phone:989-345-5240
Practice Address - Fax:989-345-4513
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704103298363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704103298OtherSTATE LICENSE
MI5181615Medicaid
MI700G210140OtherBCBS GROUP
MI5008770700OtherBCBS PIN
MI5181590Medicaid
MI5206483Medicaid
MI700G210140OtherBCBS GROUP
MI5181615Medicaid