Healthcare Provider Details

I. General information

NPI: 1184296519
Provider Name (Legal Business Name): ANN MARIE MILLER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN MARIE NELSON

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK NICOLLET BLVD
ST LOUIS PARK MN
55416-2527
US

IV. Provider business mailing address

4800 EXCELSIOR BLVD APT 323
ST LOUIS PARK MN
55416-3056
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-2000
  • Fax:
Mailing address:
  • Phone: 708-362-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number518175
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: