Provider Demographics
NPI:1215501895
Name:MILLER, LILLIAN JOY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:JOY
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 CAMINO ARTESANO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5256
Mailing Address - Country:US
Mailing Address - Phone:505-490-1549
Mailing Address - Fax:
Practice Address - Street 1:2719 CAMINO ARTESANO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5256
Practice Address - Country:US
Practice Address - Phone:505-490-1549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM63706163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant