Individual
MR. MARK DANIEL MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, AGACNP
Contact information
Practice address
1 CELLINI PL STE 102, WEST HAVEN, CT 06516-1666
(203) 932-6481
Mailing address
124 WARREN AVE, MYSTIC, CT 06355-2131
(860) 460-6814
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
12208
CT
363LA2100X
Acute Care Nurse Practitioner
33688
TN
363LA2200X
Adult Health Nurse Practitioner
12208
CT
363LG0600X
Gerontology Nurse Practitioner
12208
CT
Other
Enumeration date
10/12/2022
Last updated
03/04/2025
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