Healthcare Provider Details

I. General information

NPI: 1235724386
Provider Name (Legal Business Name): CORA ANN MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 HIGHLAND BLVD STE 3360
BOZEMAN MT
59715-6914
US

IV. Provider business mailing address

931 HIGHLAND BLVD STE 3360
BOZEMAN MT
59715-6914
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-4242
  • Fax:
Mailing address:
  • Phone: 406-587-4242
  • Fax: 406-587-3507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-173939
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNUR-APRN-LIC-173939
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: