Provider Demographics
NPI:1275594806
Name:MILLER, SOLLIE L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:SOLLIE
Middle Name:L
Last Name:MILLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 STOCKTON DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7360
Mailing Address - Country:US
Mailing Address - Phone:843-667-1141
Mailing Address - Fax:
Practice Address - Street 1:3326 STOCKTON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7360
Practice Address - Country:US
Practice Address - Phone:843-667-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2029367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1269Medicaid
SCQ335481162Medicare ID - Type Unspecified