Healthcare Provider Details

I. General information

NPI: 1699770073
Provider Name (Legal Business Name): BRIAN L. MILLER CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W 41ST ST
SIOUX FALLS SD
57106-6028
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-332-2883
  • Fax: 605-328-9620
Mailing address:
  • Phone: 605-328-6585
  • Fax: 605-328-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000273
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: