Provider Demographics
NPI:1639340250
Name:MILLER, SUSAN AILEEN (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:AILEEN
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 1:205 E UNIVERSITY AVE STE 157
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6817
Mailing Address - Country:US
Mailing Address - Phone:409-363-4757
Mailing Address - Fax:409-727-4777
Practice Address - Street 1:205 E UNIVERSITY AVE STE 157
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6817
Practice Address - Country:US
Practice Address - Phone:409-363-4757
Practice Address - Fax:409-727-4777
Is Sole Proprietor?:No
Enumeration Date:2008-03-23
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713090363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care