Provider Demographics
NPI:1366921868
Name:MILLER, DIANA JOY (CPM LM)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JOY
Last Name:MILLER
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:GREENBANK
Mailing Address - State:WA
Mailing Address - Zip Code:98253-0067
Mailing Address - Country:US
Mailing Address - Phone:360-678-3594
Mailing Address - Fax:
Practice Address - Street 1:3455 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:GREENBANK
Practice Address - State:WA
Practice Address - Zip Code:98253
Practice Address - Country:US
Practice Address - Phone:360-678-3594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60860286176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife