Provider Demographics
NPI:1194864371
Name:MILLER, CARRIE COSS (ND)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:COSS
Last Name:MILLER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18809 37TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-2713
Mailing Address - Country:US
Mailing Address - Phone:206-417-1038
Mailing Address - Fax:
Practice Address - Street 1:5603 230TH ST SW
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4617
Practice Address - Country:US
Practice Address - Phone:425-697-6112
Practice Address - Fax:425-697-3252
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine