Healthcare Provider Details

I. General information

NPI: 1609733013
Provider Name (Legal Business Name): LESLIE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W EMERALD CIR
BRANDON SD
57005-8504
US

IV. Provider business mailing address

413 W EMERALD CIR
BRANDON SD
57005-8504
US

V. Phone/Fax

Practice location:
  • Phone: 605-999-4054
  • Fax:
Mailing address:
  • Phone: 605-999-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR036219
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: