Provider Demographics
NPI:1790347268
Name:MILLER, COURTNEY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:NAASTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:3523 45TH ST S STE 100
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8962
Mailing Address - Country:US
Mailing Address - Phone:701-203-5247
Mailing Address - Fax:701-203-2903
Practice Address - Street 1:3523 45TH ST S STE 100
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8962
Practice Address - Country:US
Practice Address - Phone:701-203-5247
Practice Address - Fax:701-203-2903
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR40557363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health