Provider Demographics
NPI:1538961024
Name:MILLER, KRISTIN NICOLE SILVA (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICOLE SILVA
Last Name:MILLER
Suffix:
Gender:
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24813 THUNDER CLOUD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-6195
Mailing Address - Country:US
Mailing Address - Phone:530-383-5512
Mailing Address - Fax:
Practice Address - Street 1:24813 THUNDER CLOUD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-6195
Practice Address - Country:US
Practice Address - Phone:530-383-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDL-317450163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant