Provider Demographics
NPI:1760678874
Name:MILLER, RACHEL DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DAWN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:DAWN
Other - Last Name:WILKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9825 HOSPITAL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4769
Mailing Address - Country:US
Mailing Address - Phone:763-780-6699
Mailing Address - Fax:763-420-0500
Practice Address - Street 1:9825 HOSPITAL DR STE 105
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4769
Practice Address - Country:US
Practice Address - Phone:763-780-6699
Practice Address - Fax:763-420-0500
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical