Provider Demographics
NPI:1598753337
Name:MILLER, LINDA E (RN MSN CS APN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN MSN CS APN
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Other - First Name:
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Mailing Address - Street 1:810 DERHAKE RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5823
Mailing Address - Country:US
Mailing Address - Phone:314-388-5201
Mailing Address - Fax:636-230-0421
Practice Address - Street 1:810 DERHAKE RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5823
Practice Address - Country:US
Practice Address - Phone:314-388-5201
Practice Address - Fax:636-230-0421
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MORN554563364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
89000095OtherFEDERAL MEDICARE
MO157244OtherBLUE CROSS BLUE SHIELD
89000095OtherFEDERAL MEDICARE