Provider Demographics
NPI:1295261915
Name:MILLER, ELIZABETH (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 CHURCHILL DR
Mailing Address - Street 2:STE 300 - STE 300
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2706
Mailing Address - Country:US
Mailing Address - Phone:972-691-1240
Mailing Address - Fax:972-691-2073
Practice Address - Street 1:3041 CHURCHILL DR
Practice Address - Street 2:STE 300 - STE 300
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2706
Practice Address - Country:US
Practice Address - Phone:972-691-1240
Practice Address - Fax:972-691-2073
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX563580163W00000X
TXL-45482163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse