Provider Demographics
NPI:1811929870
Name:MILLER, NADINE
Entity type:Individual
Prefix:
First Name:NADINE
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 1:1802 WESTCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 W LAKE ST
Practice Address - Street 2:208
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3397
Practice Address - Country:US
Practice Address - Phone:612-455-3200
Practice Address - Fax:612-455-3299
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP58075OtherHEALTH PARTNERS
MN01-15068OtherMEDICA
MN34204CAOtherBLUE CROSS BLUE SHIELD
MN607627100Medicaid
MN962641046033OtherPREFERRED ONE
MNHP58075OtherHEALTH PARTNERS
MNQ61406Medicare UPIN