Provider Demographics
NPI:1659523082
Name:MILLER, STEFANIE MICHELLE (IBCLC)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:MICHELLE
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 1:1837 SE MILLER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6729
Mailing Address - Country:US
Mailing Address - Phone:617-460-0104
Mailing Address - Fax:
Practice Address - Street 1:1837 SE MILLER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6729
Practice Address - Country:US
Practice Address - Phone:617-460-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist