Provider Demographics
NPI:1164616132
Name:MILLER, LAURIE T (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:T
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:J
Other - Last Name:TRIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:71 HOLLOWCREST DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-5701
Mailing Address - Country:US
Mailing Address - Phone:570-836-4705
Mailing Address - Fax:570-996-8305
Practice Address - Street 1:71 HOLLOWCREST DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-5701
Practice Address - Country:US
Practice Address - Phone:570-836-4705
Practice Address - Fax:570-996-8305
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001049L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant