Provider Demographics
NPI:1356401335
Name:MILLER, JANIS DEANN (NP)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:DEANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 NORTH MILL STREET
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:IL
Mailing Address - Zip Code:62428
Mailing Address - Country:US
Mailing Address - Phone:217-923-3311
Mailing Address - Fax:217-923-5160
Practice Address - Street 1:302 NORTH MILL STREET
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:IL
Practice Address - Zip Code:62428
Practice Address - Country:US
Practice Address - Phone:217-923-3311
Practice Address - Fax:217-923-5160
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002505A363LF0000X
IL2009006355363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209006355OtherLICENSE
INP00435500OtherRR MEDICARE
IN200876860Medicaid
IL209006355OtherLICENSE
IN941090Z4Medicare PIN
INP00435500Medicare PIN
IN130910PPMedicare PIN
IN854700LLLLMedicare PIN
INP00435500OtherRR MEDICARE
IN200876860Medicaid