Provider Demographics
NPI:1619517729
Name:MILLER, STORMY (IBCLC)
Entity Type:Individual
Prefix:
First Name:STORMY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25326 NW 173RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-2977
Mailing Address - Country:US
Mailing Address - Phone:386-546-9765
Mailing Address - Fax:
Practice Address - Street 1:25326 NW 173RD AVE
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-2977
Practice Address - Country:US
Practice Address - Phone:386-546-9765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-159066174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN