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General NPI Number Information
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NPI Number | 1760986624
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Entity Type | Individual
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Provider Name | DIANDRA SHAKIRA MILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 3580 ARCADE ST
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127
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Country | US
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Telephone | 651-968-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 3580 ARCADE ST
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-7135
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Country | US
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Telephone | 651-968-5200
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12686
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 12686
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License Number State | MN
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