Healthcare Provider Details

I. General information

NPI: 1366921868
Provider Name (Legal Business Name): DIANA JOY MILLER CPM LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 OLD COUNTY RD
GREENBANK WA
98253
US

IV. Provider business mailing address

PO BOX 67
GREENBANK WA
98253-0067
US

V. Phone/Fax

Practice location:
  • Phone: 360-678-3594
  • Fax:
Mailing address:
  • Phone: 360-678-3594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60860286
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: