Provider Demographics
NPI:1003688441
Name:MILLER, LEZLIE MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:LEZLIE
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:LEZLIE
Other - Middle Name:MARIE
Other - Last Name:POMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5830 DERRINGER RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-9054
Mailing Address - Country:US
Mailing Address - Phone:605-881-5183
Mailing Address - Fax:
Practice Address - Street 1:113 COMANCHE RD
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:SD
Practice Address - Zip Code:57741-1002
Practice Address - Country:US
Practice Address - Phone:605-347-1609
Practice Address - Fax:612-725-1318
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0723133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered