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Individual

MADELYN MILLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APN BC

Contact information

Practice address
2105 CLEARY AVE, METAIRIE, LA 70001-1623
(419) 841-1832
Mailing address
201 N CANAL BLVD, THIBODAUX, LA 70301-2910
(866) 389-2727

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
15101-NP
OH
363LF0000X
Family Nurse Practitioner
Primary
AP03086
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
11-4946455
MI
05
11-4946464
MI
05
11-4946473
MI
05
11-4946482
MI
01
382962430001
TRICARE CHAMPUS
MI
05
4863497
MI
05
4863503
MI
05
4863512
MI
05
4863521
MI
05
4863530
MI
Enumeration date
05/17/2006
Last updated
02/09/2019
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