Basic Information
Provider Information
NPI: 1003006198
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: LAURA
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 91-2139 FORT WEAVER RD
Address2: POB SUITE 101
City: EWA BEACH
State: HI
PostalCode: 967063607
CountryCode: US
TelephoneNumber: 8086913340
FaxNumber: 8086913345
Practice Location
Address1: 91-2139 FORT WEAVER RD
Address2: POB SUITE 101
City: EWA BEACH
State: HI
PostalCode: 967063607
CountryCode: US
TelephoneNumber: 8086913340
FaxNumber: 8086913345
Other Information
ProviderEnumerationDate: 07/26/2007
LastUpdateDate: 12/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XMD16702HIY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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