MEDICARE: TAMI J MILLER CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	0024166466	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689675696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMI J MILLER CRNA

Provider Business Mailing Address
First Line	:	PO BOX 37090
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3090
Country	:	US
Telephone Number	:	804-289-4937
Fax Number	:

Provider Business Practice Location Address
First Line	:	3998 FAIR RIDGE DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2907
Country	:	US
Telephone Number	:	804-289-4937
Fax Number	:	804-565-6600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	10/06/2014

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