Provider Demographics
NPI:1013045608
Name:MILAZZO, DIA M (CRNA)
Entity Type:Individual
Prefix:
First Name:DIA
Middle Name:M
Last Name:MILAZZO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DIA
Other - Middle Name:M
Other - Last Name:TITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0125
Mailing Address - Country:US
Mailing Address - Phone:888-731-1036
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:618-463-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118840367500000X
IL041262659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q27423Medicare UPIN