Provider Demographics
NPI:1003239245
Name:MILLER, LAUREN MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:TUMELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11900 NW EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099
Mailing Address - Country:US
Mailing Address - Phone:405-283-9300
Mailing Address - Fax:405-283-9301
Practice Address - Street 1:11900 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-283-9300
Practice Address - Fax:405-283-9301
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2332363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2332OtherMEDICAL LICENSE