Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 702467 | TX |
NPI | 1003057845 |
---|---|
Provider Name | Dena Miller |
First Address | Bedford, TX 76021-6605 |
Second Address | Bedford, TX 76021-6605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2009 |
Last Update Date | 20/10/2015 |