Provider Demographics
NPI:1649743063
Name:MILLER, NICOLE ANNEE (CRNA)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ANNEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5260
Mailing Address - Country:US
Mailing Address - Phone:337-366-7636
Mailing Address - Fax:
Practice Address - Street 1:200 GREENLEAVES BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7018
Practice Address - Country:US
Practice Address - Phone:855-300-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN137829367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered