Provider Demographics
NPI:1326698143
Name:MILLER, CRYSTAL ANN (RRT, DHA)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RRT, DHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SW RIVERVIEW PL
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-6773
Mailing Address - Country:US
Mailing Address - Phone:503-875-1922
Mailing Address - Fax:
Practice Address - Street 1:77 SW RIVERVIEW PL
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-6773
Practice Address - Country:US
Practice Address - Phone:503-875-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101777762279C0205X
WALR0003193227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered