Provider Demographics
NPI:1730215096
Name:MILLER, DEBORAH ELAINE (FNP,RN,PHN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP,RN,PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11210 SNAPDRAGON ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1946
Mailing Address - Country:US
Mailing Address - Phone:661-618-0021
Mailing Address - Fax:
Practice Address - Street 1:2125 KNOLL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7329
Practice Address - Country:US
Practice Address - Phone:805-981-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHN 70874171M00000X
CANP 6455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF0795044OtherAANP CERTIFICATION PROGRA
ARRN 255382OtherRN LICENSE
ARNP 6455OtherNP LICENSE