Provider Demographics
NPI:1457338352
Name:MILLER HEERY, GRETCHEN H (NP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:H
Last Name:MILLER HEERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:HOPE
Other - Last Name:HEERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 746722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3621 ARAMINGO AVE STE 5C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4607
Practice Address - Country:US
Practice Address - Phone:215-444-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007079363L00000X
MECNP251273363L00000X
PARN335796L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P52403Medicare UPIN
055566Medicare ID - Type Unspecified