Provider Demographics
NPI:1871326892
Name:MILLER, MARY ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
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:PO BOX 2316
Mailing Address - Street 2:
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-2316
Mailing Address - Country:US
Mailing Address - Phone:805-602-1633
Mailing Address - Fax:
Practice Address - Street 1:3960 VIRGINIA BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2449
Practice Address - Country:US
Practice Address - Phone:757-668-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily