Individual
MRS. MELISSA N MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2809 N PARK DRIVE LN, APPLETON, WI 54911-1603
(920) 380-4999
Mailing address
2809 N PARK DRIVE LN, APPLETON, WI 54911-1603
(920) 380-4999
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
085003857
IL
363AM0700X
Medical Physician Assistant
Primary
4250
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10115176
BCBSIL GROUP
IL
01
—
363502461001
TRICARE
IL
01
—
769380
MEDICARE GROUP PTAN
IL
Enumeration date
09/20/2010
Last updated
03/17/2018
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