Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | M9155 | ID |
NPI | 1245236983 |
---|---|
Provider Name | Dr. Jennifer Rawlings Miller |
First Address | Boise, ID 83706-3009 |
Second Address | Boise, ID 83706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 16/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245236983 | (05) | ID |
H99490 | (02) | ID |