Provider Demographics
NPI:1902314586
Name:MILLER, JESSICA ANN (RN, MSN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, MSN
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 162
Mailing Address - Street 2:
Mailing Address - City:VENANGO
Mailing Address - State:PA
Mailing Address - Zip Code:16440-0162
Mailing Address - Country:US
Mailing Address - Phone:814-720-8016
Mailing Address - Fax:
Practice Address - Street 1:680 BLAIR MILL RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044
Practice Address - Country:US
Practice Address - Phone:215-902-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018985363LF0000X
PARN578324163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily