Healthcare Provider Details

I. General information

NPI: 1639112212
Provider Name (Legal Business Name): LORI JANE MILLER RN, WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 EXCHANGE ST W STE 622
SAINT PAUL MN
55102-1225
US

IV. Provider business mailing address

1655 BEAM AVE STE 102
MAPLEWOOD MN
55109-1475
US

V. Phone/Fax

Practice location:
  • Phone: 651-297-9141
  • Fax:
Mailing address:
  • Phone: 651-257-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR155474-6
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: