Provider Demographics
NPI:1700972882
Name:MILLER, ROBERT A (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
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 1:617 N CHESTNUT
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420
Mailing Address - Country:US
Mailing Address - Phone:785-738-0230
Mailing Address - Fax:785-738-9328
Practice Address - Street 1:400 W 8TH
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420
Practice Address - Country:US
Practice Address - Phone:785-738-9323
Practice Address - Fax:785-738-9328
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-38177-062367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS145173Medicare ID - Type Unspecified
KSR31901Medicare UPIN