MEDICARE: MRS. CECELIA WHITE MILLS 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	163W00000X	Registered Nurse	117440	NC
2	367500000X	Certified Registered Nurse Anesthetist	88354	NC

General Provider Information

NPI Number	:	1699069971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CECELIA WHITE MILLS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 535395
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-5321
Country	:	US
Telephone Number	:	800-243-3839
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 LAKE BOONE TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7505
Country	:	US
Telephone Number	:	919-491-7790
Fax Number	:

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

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	05/18/2022

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