Individual
MICHELLE R MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
325 MDG, 340 MAGMOLIA CIR, TYNDALL, AFB, FL 32403
(608) 797-6826
Mailing address
325 MDG, 340 MAGMOLIA CIR, TYNDALL, AFB, FL 32403
(608) 797-6826
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1349
WI
363AM0700X
Medical Physician Assistant
1843
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41921900
—
WI
Enumeration date
06/13/2005
Last updated
05/09/2018
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