Healthcare Provider Details

I. General information

NPI: 1689965725
Provider Name (Legal Business Name): HEATHER STARR MILLER RN,BSN,IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2011
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 SIX FORKS RD SUITE 111
RALEIGH NC
27609-3838
US

IV. Provider business mailing address

5904 SIX FORKS RD SUITE 111
RALEIGH NC
27609-3838
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-9555
  • Fax: 919-510-5111
Mailing address:
  • Phone: 919-787-9555
  • Fax: 919-510-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172308
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number10912431
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: