Provider Demographics
NPI:1639112212
Name:MILLER, LORI JANE (RN, WHCNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 BEAM AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1475
Mailing Address - Country:US
Mailing Address - Phone:651-257-9622
Mailing Address - Fax:
Practice Address - Street 1:17 EXCHANGE ST W STE 622
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1225
Practice Address - Country:US
Practice Address - Phone:651-297-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR155474-6363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN684421900Medicaid
07-04740OtherMEDICA PROVIDER ID #
MN519P1MIOtherBCBS MN PROVIDER ID #
HP62465OtherHEALTH PARTNERS ID #
1046752OtherPREFERRED ONE ID #
2435603OtherAMERICA'S PPO ID #