Provider Demographics
NPI:1386344919
Name:MILLER, CATHY JANE (LAC)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:JANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14482 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21636-1356
Mailing Address - Country:US
Mailing Address - Phone:410-253-8882
Mailing Address - Fax:
Practice Address - Street 1:14482 POPLAR ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:MD
Practice Address - Zip Code:21636-1356
Practice Address - Country:US
Practice Address - Phone:410-253-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist