Provider Demographics
NPI:1720351646
Name:MILLER, LISA R (BS,IBCLC,RLC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:BS,IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 FOX CHASE DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27370-7778
Mailing Address - Country:US
Mailing Address - Phone:336-669-7209
Mailing Address - Fax:
Practice Address - Street 1:7495 FOX CHASE DR
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:NC
Practice Address - Zip Code:27370-7778
Practice Address - Country:US
Practice Address - Phone:336-669-7209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133N00000XDietary & Nutritional Service ProvidersNutritionist