Healthcare Provider Details

I. General information

NPI: 1306405360
Provider Name (Legal Business Name): BOBBIE JO MARIE MILLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N MAPLE ST
OSMOND NE
68765-5726
US

IV. Provider business mailing address

402 N MAPLE ST
OSMOND NE
68765-5726
US

V. Phone/Fax

Practice location:
  • Phone: 402-748-3393
  • Fax:
Mailing address:
  • Phone: 402-748-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112803
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: