Individual
MR. ETTHAN CHARLES MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
360 VIRGINIA AVE STE A, WYTHEVILLE, VA 24382-1185
(276) 620-4246
Mailing address
360 VIRGINIA AVE STE A, WYTHEVILLE, VA 24382-1185
(276) 335-2038
(276) 625-8865
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
0001111520
VA
163WX0106X
Occupational Health Registered Nurse
0001111520
VA
363LF0000X
Family Nurse Practitioner
Primary
0024172389
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336546209
—
VA
Enumeration date
11/20/2014
Last updated
05/01/2025
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