Provider Demographics
NPI:1811650518
Name:MILLER, BETHANIE MICHELLE (CNP)
Entity type:Individual
Prefix:
First Name:BETHANIE
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 OHMS LN
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2148
Mailing Address - Country:US
Mailing Address - Phone:952-841-2345
Mailing Address - Fax:
Practice Address - Street 1:1725 LEGACY PKWY E STE 100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5434
Practice Address - Country:US
Practice Address - Phone:952-841-2345
Practice Address - Fax:952-841-2346
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily