Healthcare Provider Details

I. General information

NPI: 1134034861
Provider Name (Legal Business Name): BRYN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 GRAND AVE
WEST DES MOINES IA
50266-5360
US

IV. Provider business mailing address

2129 105TH ST
FAIRMONT MN
56031-4624
US

V. Phone/Fax

Practice location:
  • Phone: 515-271-1569
  • Fax:
Mailing address:
  • Phone: 507-848-4245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: