Provider Demographics
NPI:1699001818
Name:MILLER, PAMELA ANN (PHN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N HOLCOMBE AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-2210
Mailing Address - Country:US
Mailing Address - Phone:320-693-5370
Mailing Address - Fax:320-693-5399
Practice Address - Street 1:114 N HOLCOMBE AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-2210
Practice Address - Country:US
Practice Address - Phone:320-693-5370
Practice Address - Fax:320-693-5399
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1011369-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse