MEDICARE: NADINE 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	363AM0700X	Medical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HP58075	OTHER	MN	HEALTH PARTNERS
2	01-15068	OTHER	MN	MEDICA
3	34204CA	OTHER	MN	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	962641046033	OTHER	MN	PREFERRED ONE

General Provider Information

NPI Number	:	1811929870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE MILLER

Provider Business Mailing Address
First Line	:	1802 WESTCHESTER LN
Second Line	:
City	:	SHAKOPEE
State	:	MN
Zip	:	55379-4566
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W LAKE ST
Second Line	:	208
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3397
Country	:	US
Telephone Number	:	612-455-3200
Fax Number	:	612-455-3299

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	05/21/2008

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Directions to “ NADINE MILLER ” Practice Location

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