Provider Demographics
NPI:1780913749
Name:MILLER, JUSTINE MARIE (PA)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:MARIE
Other - Last Name:CANIGLIA-MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:402-559-4424
Mailing Address - Fax:402-559-7929
Practice Address - Street 1:988102 NEBRASKA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-8102
Practice Address - Country:US
Practice Address - Phone:402-559-4424
Practice Address - Fax:402-559-7929
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026059800Medicaid
NE098605322Medicare PIN