Provider Demographics
NPI:1407956881
Name:MILLER, LA TARA ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LA TARA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 BRAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2405
Mailing Address - Country:US
Mailing Address - Phone:301-877-3045
Mailing Address - Fax:301-877-8712
Practice Address - Street 1:50 IRVING ST NW
Practice Address - Street 2:1E236
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8000
Practice Address - Fax:202-745-8530
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN964584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily