Provider Demographics
NPI:1134168164
Name:MILLER, DAN L (ARNP)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 N BROADWAY
Mailing Address - Street 2:PBO
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1409
Mailing Address - Country:US
Mailing Address - Phone:425-317-6099
Mailing Address - Fax:425-317-0291
Practice Address - Street 1:1001 N BROADWAY
Practice Address - Street 2:SUITE A-3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1586
Practice Address - Country:US
Practice Address - Phone:425-317-0300
Practice Address - Fax:425-317-0303
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9638651Medicaid
WAG8877601Medicare PIN
WAAB39977Medicare ID - Type Unspecified
WA9638651Medicaid