Basic Information
| Provider Information | |||||||||
| NPI: | 1790793594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | SHELLEY | ||||||||
| MiddleName: | RENEA | ||||||||
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| Credential: | RN MSN FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2377 | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242662607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2768893700 | ||||||||
| FaxNumber: | 2768895505 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 EAST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2768893700 | ||||||||
| FaxNumber: | 2768895505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024000081 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 010204534 | 05 | VA | MEDICAID | 010204518 | 05 | VA | MEDICAID |