Provider Demographics
NPI:1508556234
Name:MILLER, LISA R
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S CECIL ST
Mailing Address - Street 2:
Mailing Address - City:BONDUEL
Mailing Address - State:WI
Mailing Address - Zip Code:54107-9260
Mailing Address - Country:US
Mailing Address - Phone:920-419-5454
Mailing Address - Fax:
Practice Address - Street 1:310 S CECIL ST
Practice Address - Street 2:
Practice Address - City:BONDUEL
Practice Address - State:WI
Practice Address - Zip Code:54107-9260
Practice Address - Country:US
Practice Address - Phone:920-419-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)