=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467314112
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAYNE MILLER JR. FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 ANNE ST NW
-----------------------------------------------------
City | BEMIDJI
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56601-5103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-333-4680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 ANNE ST NW
-----------------------------------------------------
City | BEMIDJI
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56601-5103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-333-4680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 13687
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------