MEDICARE: KATHERINE ANNE MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1043711641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANNE MILLER

Provider Business Mailing Address
First Line	:	3900 BETHEL DR # 1666
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-6902
Country	:	US
Telephone Number	:	626-290-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 BETHEL DR # 1666
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-6902
Country	:	US
Telephone Number	:	626-290-2707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/28/2018

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