Provider Demographics
NPI:1043410830
Name:MILLIRON, LORI BETH (CPNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:MILLIRON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8999
Mailing Address - Fax:937-438-1291
Practice Address - Street 1:1516 YANKEE PARK PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1878
Practice Address - Country:US
Practice Address - Phone:937-438-1115
Practice Address - Fax:937-438-1291
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.315948363L00000X
OHCOA 09845NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000722789OtherBCBS OHIO
OH9760718OtherAETNA
OH0053983Medicaid
OH421534506178OtherCARESOURCE OHIO
OH1043410830OtherMEDICAL MUTUAL OF OHIO
OH9760718OtherAETNA