Individual
LISA ANN MILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2900 THOMAS AVE S STE 100, MINNEAPOLIS, MN 55416
(612) 979-2276
Mailing address
4301 ELLIOT AVE, MINNEAPOLIS, MN 55407-3156
(512) 708-7562
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
R125294-1
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3654
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107D0MI
BCBS
MN
01
—
1093741886
PATIENT CHOICE
MN
05
—
500008053
—
MN
01
—
HP 23925
HEALTHPARTNERS
MN
Enumeration date
06/23/2006
Last updated
08/14/2021
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