Provider Demographics
NPI:1629418041
Name:MILLER, ANDREA SUE (NP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 OKEMOS RD STE 12
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:517-201-0607
Practice Address - Street 1:4211 OKEMOS RD STE 12
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3287
Practice Address - Country:US
Practice Address - Phone:517-214-9779
Practice Address - Fax:517-201-0607
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2025-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704255922363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629418041Medicaid
MI1629418041Medicaid