Healthcare Provider Details

I. General information

NPI: 1831619840
Provider Name (Legal Business Name): LYNDA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 DESERT MOUNTAIN RD NE
ALBUQUERQUE NM
87122-3614
US

IV. Provider business mailing address

9605 DESERT MOUNTAIN RD NE
ALBUQUERQUE NM
87122-3614
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-0668
  • Fax:
Mailing address:
  • Phone: 505-220-0668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR44172
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: