MEDICARE: HEATHER NICOLE MILLER PA-C

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	363AM0700X	Medical Physician Assistant	9922	MN

General Provider Information

NPI Number	:	1760474480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER NICOLE MILLER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 14909
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-0909
Country	:	US
Telephone Number	:	612-871-1145
Fax Number	:	651-641-0556

Provider Business Practice Location Address
First Line	:	2550 UNIVERSITY AVE W
Second Line	:	SUITE 423 SOUTH
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1052
Country	:	US
Telephone Number	:	612-870-5557
Fax Number	:	612-870-5857

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	03/24/2008

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