Healthcare Provider Details

I. General information

NPI: 1336796663
Provider Name (Legal Business Name): ANDREW WILLIAM MILLER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LAUREL ST STE A120
DES MOINES IA
50314-3027
US

IV. Provider business mailing address

PO BOX 1475
DES MOINES IA
50305-1475
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-7900
  • Fax: 515-643-7901
Mailing address:
  • Phone: 515-643-7900
  • Fax: 515-643-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH155890
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberH155890
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: