=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811859499
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDIS MILLER RDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 1ST ST SE
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55052-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-412-1351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55052-0025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-412-1351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------