Provider Demographics
NPI:1679749279
Name:MILLER, ANGELA L (CNM)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:34509 9TH AVE S STE 207
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8709
Mailing Address - Country:US
Mailing Address - Phone:253-815-9595
Mailing Address - Fax:360-825-3370
Practice Address - Street 1:34509 9TH AVE S STE 207
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8709
Practice Address - Country:US
Practice Address - Phone:253-815-9595
Practice Address - Fax:360-825-3370
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60042863363LW0102X, 367A00000X
367A00000X
NC514367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9658402Medicaid
WA0239392OtherSTATE L&I
WA1092460Medicaid