Provider Demographics
NPI:1982627683
Name:MILLER, LAURA G (RN,CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:G
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN,CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8832 LACROSSE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4826
Mailing Address - Country:US
Mailing Address - Phone:214-221-4522
Mailing Address - Fax:214-221-4522
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:CRNA
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-820-2170
Practice Address - Fax:214-820-7977
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX410375367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR70142Medicare UPIN
TX8B4469Medicare ID - Type Unspecified