Healthcare Provider Details

I. General information

NPI: 1861707549
Provider Name (Legal Business Name): LINSEY M.S. MILLER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 NW 138TH ST STE 200
CLIVE IA
50325-8300
US

IV. Provider business mailing address

1350 NW 138TH ST STE 200
CLIVE IA
50325-8300
US

V. Phone/Fax

Practice location:
  • Phone: 515-758-8300
  • Fax:
Mailing address:
  • Phone: 515-758-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG182026
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-92752-092
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: