Provider Demographics
NPI:1942720917
Name:MILLER, LAUREN (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 N STORY RD APT 8311A
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-5909
Mailing Address - Country:US
Mailing Address - Phone:316-880-0140
Mailing Address - Fax:
Practice Address - Street 1:3909 W AIRPORT FWY STE 109
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5905
Practice Address - Country:US
Practice Address - Phone:316-880-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier