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Organization
MILES MED MANAGEMENT SERVICE CORPORATION
Active
Organization
MILES MED MANAGEMENT SERVICE CORPORATION
Active
Other names
Miles Med Management
Organization subpart
No
Provider details
NPI number
Authorized official
LISA ANN MILES APNP (NURSE PRACTITIONER)
(612) 708-7562
Entity
Organization
Contact information
Practice address
5775 WAYZATA BLVD STE 767, SAINT LOUIS PARK, MN 55416-1222
(612) 708-7562
(507) 738-1963
Mailing address
4301 ELLIOT AVE, MINNEAPOLIS, MN 55407-3156
(612) 708-7562
(507) 738-1963
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093741886
—
MN
05
—
1225703705
—
MN
Enumeration date
08/16/2021
Last updated
09/15/2021
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