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Individual

LISA M MILLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1950 E CLARK ST STE 110, POCATELLO, ID 83201-3315
(208) 252-5021
(208) 205-8040
Mailing address
1950 E CLARK ST STE 110, POCATELLO, ID 83201-3315
(208) 252-5021
(208) 205-8040

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
70995
ID

Other

Enumeration date
02/01/2022
Last updated
11/20/2024
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