Provider Demographics
NPI:1538913454
Name:MILLER, MICHAELA MARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MICHAELA
Other - Middle Name:MARIE
Other - Last Name:ORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-4259
Mailing Address - Country:US
Mailing Address - Phone:217-822-6161
Mailing Address - Fax:
Practice Address - Street 1:408 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-1010
Practice Address - Country:US
Practice Address - Phone:217-826-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015099A363LF0000X
IL209029479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily