MEDICARE: GINA ELIZABETH 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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1962148288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA ELIZABETH MILLER

Provider Business Mailing Address
First Line	:	5820 TIOGA ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55804-2553
Country	:	US
Telephone Number	:	218-464-7507
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 TIOGA ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55804-2553
Country	:	US
Telephone Number	:	218-464-7507
Fax Number	:

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

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/10/2022

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