Healthcare Provider Details

I. General information

NPI: 1063123834
Provider Name (Legal Business Name): VANESSA JANE MILLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA JANE MILLER VANESSA HAZELTON

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 MICHIGAN AVE W
WALKER MN
56484-2276
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 218-547-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA172189
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13917
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: