MEDICARE: LORI JANE MILLER RN, WHCNP

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	363LW0102X	Women's Health Nurse Practitioner	R155474-6	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	07-04740	OTHER		MEDICA PROVIDER ID #
3	519P1MI	OTHER	MN	BCBS MN PROVIDER ID #
4	HP62465	OTHER		HEALTH PARTNERS ID #
5	1046752	OTHER		PREFERRED ONE ID #
6	2435603	OTHER		AMERICA'S PPO ID #

General Provider Information

NPI Number	:	1639112212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI JANE MILLER RN, WHCNP

Provider Business Mailing Address
First Line	:	1655 BEAM AVE
Second Line	:	STE 102
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1475
Country	:	US
Telephone Number	:	651-257-9622
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 EXCHANGE ST W STE 622
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-1225
Country	:	US
Telephone Number	:	651-297-9141
Fax Number	:

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	10/31/2019

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