Provider Demographics
NPI:1356873558
Name:MILLER FAMILY HEALTHCARE LLC
Entity type:Organization
Organization Name:MILLER FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:SELENA
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:304-530-5980
Mailing Address - Street 1:206 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1287
Mailing Address - Country:US
Mailing Address - Phone:304-530-5980
Mailing Address - Fax:304-530-5981
Practice Address - Street 1:206 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1287
Practice Address - Country:US
Practice Address - Phone:304-530-5980
Practice Address - Fax:304-530-5981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty