MEDICARE: LISA M MILLER FNP-C

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	363LF0000X	Family Nurse Practitioner	71001974A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942296009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M MILLER FNP-C

Provider Business Mailing Address
First Line	:	1116 MILLIS AVE STE 101
Second Line	:
City	:	BOONVILLE
State	:	IN
Zip	:	47601-2226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1116 MILLIS AVE
Second Line	:	STE 101
City	:	BOONVILLE
State	:	IN
Zip	:	47601-2292
Country	:	US
Telephone Number	:	812-897-7107
Fax Number	:

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	10/10/2024

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