Healthcare Provider Details

I. General information

NPI: 1497998363
Provider Name (Legal Business Name): LYNN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W5570 BILLS LN
NECEDAH WI
54646-7613
US

IV. Provider business mailing address

W5570 BILLS LN
NECEDAH WI
54646-7613
US

V. Phone/Fax

Practice location:
  • Phone: 608-547-9482
  • Fax:
Mailing address:
  • Phone: 608-547-9482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number164335030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: