Provider Demographics
NPI:1841367455
Name:KRONMILLER, MICAH PATRICK (CRNA MS)
Entity type:Individual
Prefix:MR
First Name:MICAH
Middle Name:PATRICK
Last Name:KRONMILLER
Suffix:
Gender:M
Credentials:CRNA MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6277 S 2225 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-5301
Mailing Address - Country:US
Mailing Address - Phone:801-920-0743
Mailing Address - Fax:
Practice Address - Street 1:4364 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1866
Practice Address - Country:US
Practice Address - Phone:801-436-1637
Practice Address - Fax:801-476-7002
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3804384406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered