Provider Demographics
NPI:1710713540
Name:MILLER, BRIELLE ALEXIS
Entity type:Individual
Prefix:
First Name:BRIELLE
Middle Name:ALEXIS
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3274 MOAK ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-7822
Mailing Address - Country:US
Mailing Address - Phone:810-824-9488
Mailing Address - Fax:
Practice Address - Street 1:3274 MOAK ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-7822
Practice Address - Country:US
Practice Address - Phone:810-824-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant