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General NPI Number Information
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NPI Number | 1093741886
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Entity Type | Individual
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Provider Name | LISA ANN MILES CNP
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 08/14/2021
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Provider Practice Location Address
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Address Line | 2900 THOMAS AVE S STE 100
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City | MINNEAPOLIS
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State | MN
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Zip | 55416
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Country | US
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Telephone | 612-979-2276
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 ELLIOT AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-3156
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Country | US
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Telephone | 512-708-7562
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | R125294-1
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3654
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License Number State | MN
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