Healthcare Provider Details

I. General information

NPI: 1356313985
Provider Name (Legal Business Name): BRIAN EDWARD MILLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BARTLETT ST
HOMER AK
99603-7005
US

IV. Provider business mailing address

4300 BARTLETT ST
HOMER AK
99603-7005
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-0260
  • Fax: 907-235-0289
Mailing address:
  • Phone: 907-235-0260
  • Fax: 907-235-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNURA433
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: