Lacey Miller, LPN
Individual provider Active NPI Licensed Practical Nurse · Lake Wilson, MN
NPI 1376825265 · NPPES record last updated Sep 15, 2011
Key facts
- NPI
- 1376825265
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- L 071860-6 (MN)
- Practice address
- 697 171St St
Lake Wilson, MN 56151-1047 - Phone
- (507) 227-1776
- NPI assigned
- Sep 15, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L 071860-6 | MN | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | L 071860-6 | MN | Yes |
Addresses
Primary practice location
697 171St St
Lake Wilson, MN 56151-1047
Mailing address
697 171St St
Lake Wilson, MN 56151-1047
Phone (507) 227-1776
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.