Provider Demographics
NPI:1750989778
Name:MILLER, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:ND
Mailing Address - Zip Code:58059-4047
Mailing Address - Country:US
Mailing Address - Phone:701-331-9442
Mailing Address - Fax:
Practice Address - Street 1:309 19TH AVE W
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-4614
Practice Address - Country:US
Practice Address - Phone:701-331-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant