Provider Demographics
NPI:1699547026
Name:MILLER, HEATHER (RD, LMNT, LD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, LMNT, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 N 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1841
Mailing Address - Country:US
Mailing Address - Phone:140-225-0103
Mailing Address - Fax:
Practice Address - Street 1:8211 N 163RD AVE
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1841
Practice Address - Country:US
Practice Address - Phone:140-225-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118110133V00000X
NE651133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered