Provider Demographics
NPI:1336257476
Name:MILLER, WILLIAM M (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
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 1:1213 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-2057
Mailing Address - Country:US
Mailing Address - Phone:712-755-5161
Mailing Address - Fax:712-755-4312
Practice Address - Street 1:1213 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2057
Practice Address - Country:US
Practice Address - Phone:712-755-4349
Practice Address - Fax:712-755-4290
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA038240367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2234534Medicaid
R02792Medicare UPIN
IA1725Medicare PIN