Provider Demographics
NPI:1770063232
Name:MILLER, KRISTI
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 CALISTOGA LN APT 201
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-8738
Mailing Address - Country:US
Mailing Address - Phone:916-947-5714
Mailing Address - Fax:
Practice Address - Street 1:4720 CALISTOGA LN APT 201
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-8738
Practice Address - Country:US
Practice Address - Phone:916-947-5714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator