Provider Demographics
NPI:1316290034
Name:MILLER, LAUREL KATHLYNE (LAUREL MILLER)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:KATHLYNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAUREL MILLER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 SILMAN ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2697
Mailing Address - Country:US
Mailing Address - Phone:248-812-9459
Mailing Address - Fax:
Practice Address - Street 1:1640 SILMAN ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2697
Practice Address - Country:US
Practice Address - Phone:248-812-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist