Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | H104189 | IA |
NPI | 1023462108 |
---|---|
Provider Name | Kerry Miller |
First Address | Davenport, IA 52804-1853 |
Second Address | Davenport, IA 52804-1853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 21/06/2021 |