Provider Demographics
NPI:1932634631
Name:MILLER, TERI (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1114
Mailing Address - Country:US
Mailing Address - Phone:952-201-3367
Mailing Address - Fax:
Practice Address - Street 1:9680 TAMARACK RD STE 130
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2623
Practice Address - Country:US
Practice Address - Phone:651-265-7575
Practice Address - Fax:651-265-7580
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP5069363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics