Provider Demographics
NPI:1093918195
Name:MILLER, KAREN LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNNE
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2601 CHERRY AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4203
Mailing Address - Country:US
Mailing Address - Phone:360-479-4580
Mailing Address - Fax:360-479-0424
Practice Address - Street 1:17191 BOTHELL WAY NE
Practice Address - Street 2:SUITE 205
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-5534
Practice Address - Country:US
Practice Address - Phone:206-364-8272
Practice Address - Fax:206-364-5418
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB25977OtherMEDICARE GROUP
WA8018368Medicaid
WAG27142Medicare UPIN
WAG8865810Medicare PIN