MEDICARE: MRS. TRUDY KATHLEEN MILLER RN, RD/LD, CDE

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	133V00000X	Registered Dietitian	LD705	OK
2	163W00000X	Registered Nurse	R23475	OK

General Provider Information

NPI Number	:	1508135070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRUDY KATHLEEN MILLER RN, RD/LD, CDE

Provider Business Mailing Address
First Line	:	1913 SANDY LANE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-1152
Country	:	US
Telephone Number	:	405-789-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 SANDY LANE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-1152
Country	:	US
Telephone Number	:	405-789-0050
Fax Number	:

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

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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