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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