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NPI Code Detail

MEDICARE: MCKENNA MILLER B.A.

MEDICARE: MCKENNA MILLER B.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1184192171
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKENNA MILLER B.A.
Provider Business Mailing Address
First Line : 4856 INNOVATION DR STE B
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-5540
Country : US
Telephone Number : 970-494-4200
Fax Number :
Provider Business Practice Location Address
First Line : 2001 S SHIELDS ST STE G
Second Line :
City : FORT COLLINS
State : CO
Zip : 80526-1834
Country : US
Telephone Number : 970-494-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2018
Last Update Date : 06/03/2019

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Directions to “ MCKENNA MILLER B.A.” Practice Location

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