Individual
JUDITH L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4695 SHORELINE DR, SPRING PARK, MN 55384-9715
(952) 442-7890
(952) 442-7893
Mailing address
4695 SHORELINE DR, SPRING PARK, MN 55384-9715
(952) 442-7890
(952) 442-7893
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R0732886
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
412726900
—
MN
01
—
R0732886
RN LICENSE
MN
Enumeration date
07/21/2005
Last updated
05/13/2008
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