Basic Information
Provider Information
NPI: 1659567865
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: LAURA
MiddleName: COHEN
NamePrefix: MRS.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1301 CONCORD TER
Address2:  
City: SUNRISE
State: FL
PostalCode: 333232843
CountryCode: US
TelephoneNumber: 8002433839
FaxNumber:  
Practice Location
Address1: 1301 CONCORD TER
Address2:  
City: SUNRISE
State: FL
PostalCode: 333232843
CountryCode: US
TelephoneNumber: 8002433839
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/20/2007
LastUpdateDate: 09/20/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WN0002XRN099019LAY Nursing Service ProvidersRegistered NurseNeonatal Intensive Care

No ID Information.


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