Active NPI
Mary Elizabeth Miller
- Registered Dietitian
- Stillwater, MN
National Provider Identifier
1003482647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2637-29
- Practice address
- 927 Churchill St W
Stillwater, MN 55082-6605 - Phone
- (651) 430-8715
- Fax
- (651) 430-8716
- NPI assigned
- Jun 3, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2637-29 | WI | Primary |
Addresses
Primary practice location
927 Churchill St W
Stillwater, MN 55082-6605
Mailing address
927 Churchill St W
Stillwater, MN 55082-6605
Phone (651) 430-8715
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2637-29 | WI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622678400000",
"number": "1003482647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "927 CHURCHILL ST W",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550826605",
"telephone_number": "651-430-8715",
"fax_number": "651-430-8716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "927 CHURCHILL ST W",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550826605",
"telephone_number": "651-430-8715",
"fax_number": "651-430-8716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "MARY",
"middle_name": "ELIZABETH",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-03",
"last_updated": "2021-06-03",
"certification_date": "2021-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WI",
"license": "2637-29",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stillwater, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.