Provider Demographics
NPI:1518683648
Name:MILLER, OLIVIA (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROOKS LN STE 240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3750
Mailing Address - Country:US
Mailing Address - Phone:412-469-1002
Mailing Address - Fax:412-469-8925
Practice Address - Street 1:1200 BROOKS LN STE 240
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3750
Practice Address - Country:US
Practice Address - Phone:412-469-1002
Practice Address - Fax:412-469-8925
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
15852555OtherCAQH
PA104120968Medicaid