Provider Demographics
NPI:1669250932
Name:MILLER, JULIE ANNE (FNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5188
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-1188
Mailing Address - Country:US
Mailing Address - Phone:218-232-3324
Mailing Address - Fax:
Practice Address - Street 1:135 PINE TREE DR
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628-4346
Practice Address - Country:US
Practice Address - Phone:218-743-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10782OtherCERTIFIED NURSE PRACTITIONER LICENSE NUMBER