Organization
LISA M MILLER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M MILLER APRN (OWNER)
(208) 741-6159
Entity
Organization
Contact information
Practice address
1950 E CLARK ST STE 10, POCATELLO, ID 83201-3314
(208) 741-6159
Mailing address
941 CASTLE ST, CHUBBUCK, ID 83202-3010
(208) 741-6159
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/24/2024
Last updated
10/24/2024
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