Provider Demographics
NPI:1790077006
Name:MILLER, AUDRA KIRSTEN (MD)
Entity Type:Individual
Prefix:MS
First Name:AUDRA
Middle Name:KIRSTEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 IRVING ST NW
Mailing Address - Street 2:DEPT OF OPHTHALMOLGY
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3017
Mailing Address - Country:US
Mailing Address - Phone:202-877-5658
Mailing Address - Fax:202-877-7743
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:DEPT OF OPHTHALMOLGY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-5658
Practice Address - Fax:202-877-7743
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program