Provider Demographics
NPI:1841608643
Name:MILTENBERGER, JAMIE JUSTINE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:JUSTINE
Last Name:MILTENBERGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:JUSTINE
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:44-361 NILU ST APT 6
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2654
Mailing Address - Country:US
Mailing Address - Phone:937-572-6559
Mailing Address - Fax:
Practice Address - Street 1:3288 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1469
Practice Address - Country:US
Practice Address - Phone:808-432-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9287023367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9287023OtherLICENSE
HIAPRN-2247OtherAPRN LICENSE
FLARNP9287023OtherARNP LICENSE
VALNP0024174595OtherLNP LICENSE
HIRN-859964OtherRN LICENSE
VARN0001270721OtherRN LICENSE