Provider Demographics
NPI:1790878205
Name:MILLER, KRIS ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:ANN
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 1:740 N MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161
Mailing Address - Country:US
Mailing Address - Phone:734-240-5238
Mailing Address - Fax:734-240-5273
Practice Address - Street 1:740 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161
Practice Address - Country:US
Practice Address - Phone:734-240-5238
Practice Address - Fax:734-240-5273
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704186805367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4580876Medicaid
MI4580876Medicaid