MEDICARE: LAUREN MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1174041461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MILLER

Provider Business Mailing Address
First Line	:	139 W BROAD ST
Second Line	:
City	:	NORTH ENGLISH
State	:	IA
Zip	:	52316-9572
Country	:	US
Telephone Number	:	319-930-2066
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 W BROAD ST
Second Line	:
City	:	NORTH ENGLISH
State	:	IA
Zip	:	52316-9572
Country	:	US
Telephone Number	:	319-930-2066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	09/06/2017

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Directions to “ LAUREN MILLER ” Practice Location

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