Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | CP001603 | SD |
NPI | 1033762984 |
---|---|
Provider Name | Theresa Miiller |
First Address | Mitchell, SD 57301-6205 |
Second Address | Mitchell, SD 57301-6205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2019 |
Last Update Date | 19/07/2019 |