MEDICARE: DR. ELIZABETH ANN MILLER PH.D.

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	103T00000X	Psychologist	PSY-362	ID

General Provider Information

NPI Number	:	1093932303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANN MILLER PH.D.

Provider Business Mailing Address
First Line	:	100 W MAIN ST
Second Line	:	STUITE 201
City	:	BOISE
State	:	ID
Zip	:	83702-7360
Country	:	US
Telephone Number	:	208-850-4502
Fax Number	:	208-474-5237

Provider Business Practice Location Address
First Line	:	100 W MAIN ST
Second Line	:	STUITE 201
City	:	BOISE
State	:	ID
Zip	:	83702-7360
Country	:	US
Telephone Number	:	208-850-4502
Fax Number	:	208-474-5237

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/09/2007

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