Provider Demographics
NPI:1245293638
Name:MILLER, MARILYN JOYCE (PHD, CRNP, CS-P)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:JOYCE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD, CRNP, CS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 VALLEY FORGE WAY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2707
Mailing Address - Country:US
Mailing Address - Phone:410-538-4589
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER
Practice Address - Street 2:BLDG 80, AVE D
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR060407363LA2200X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult