Provider Demographics
NPI:1841696598
Name:MILLER, NICOLE LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOKAH
Mailing Address - State:MN
Mailing Address - Zip Code:55941-6500
Mailing Address - Country:US
Mailing Address - Phone:608-317-2361
Mailing Address - Fax:608-785-6315
Practice Address - Street 1:39 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOKAH
Practice Address - State:MN
Practice Address - Zip Code:55941-6500
Practice Address - Country:US
Practice Address - Phone:608-317-2361
Practice Address - Fax:608-785-6315
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI182742163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health