MEDICARE: LINDA E MILLER RN MSN CS APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	RN554563	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89000095	OTHER		FEDERAL MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	157244	OTHER	MO	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1598753337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA E MILLER RN MSN CS APN

Provider Business Mailing Address
First Line	:	810 DERHAKE RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-5823
Country	:	US
Telephone Number	:	314-388-5201
Fax Number	:	636-230-0421

Provider Business Practice Location Address
First Line	:	810 DERHAKE RD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-5823
Country	:	US
Telephone Number	:	314-388-5201
Fax Number	:	636-230-0421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/08/2007

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