Healthcare Provider Details

I. General information

NPI: 1609566140
Provider Name (Legal Business Name): KAMRYN ALEXIS MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 E LAWRENCE RD
LAWRENCEVILLE PA
16929-8801
US

IV. Provider business mailing address

34 E LAWRENCE RD
LAWRENCEVILLE PA
16929-8801
US

V. Phone/Fax

Practice location:
  • Phone: 570-827-0145
  • Fax:
Mailing address:
  • Phone: 570-827-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH075182
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: