Provider Demographics
NPI:1295086783
Name:MILLER BJORK, LAURA ALLISON (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALLISON
Last Name:MILLER BJORK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S WHITE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2603
Mailing Address - Country:US
Mailing Address - Phone:319-385-6700
Mailing Address - Fax:319-385-6703
Practice Address - Street 1:501 S WHITE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2603
Practice Address - Country:US
Practice Address - Phone:319-385-6700
Practice Address - Fax:319-385-6703
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002338363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA002338OtherSTATE LICENSE