Provider Demographics
NPI:1144931320
Name:MILLER, LINDA LOIS
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LOIS
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:LOIS
Other - Last Name:PAULSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, QDDS,QP
Mailing Address - Street 1:346 LARPENTEUR AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6712
Mailing Address - Country:US
Mailing Address - Phone:651-645-9887
Mailing Address - Fax:651-645-9884
Practice Address - Street 1:346 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-6712
Practice Address - Country:US
Practice Address - Phone:651-645-9887
Practice Address - Fax:651-645-9884
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNSSNMedicaid