| Doctor Name: | LAUREN K MIYAMASU |
| NPI Number: | 1063829240 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | COA.16242-NP |
| Business Practice Address: | 6611 Clyo Rd Ste A Centerville, OH - 454592785 |
| Business Phone Number: | 9372087300 |
| Business Fax Number: | 9372087330 |
| Mailing Address: | 6611 Clyo Rd Ste A, CENTERVILLE |
| State: | OH |
| Postal Code: | 454592785 |
| Phone Number: | 9372087300 |
| Fax Number: | 9372087330 |
| NPI Enumeration Date: | 07/19/2014 |
| NPI Last Update Date: | 09/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | COA.16242-NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |