Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | AC003392 | MD |
Y | 363LP2300X | Nurse Practitioner - Primary Care | AC003392 | MD |
NPI | 1003417163 |
---|---|
Provider Name | Lala Ann Miner |
First Address | Linthicum Heights, MD 21090-2958 |
Second Address | Cumberland, MD 21502-1564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2020 |
Last Update Date | 19/08/2021 |