Healthcare Provider Details

I. General information

NPI: 1407956881
Provider Name (Legal Business Name): LA TARA ANN MILLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW 1E236
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

7711 BRAMPTON CT
UPPER MARLBORO MD
20772-2405
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax: 202-745-8530
Mailing address:
  • Phone: 301-877-3045
  • Fax: 301-877-8712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN964584
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: