Healthcare Provider Details

I. General information

NPI: 1245707629
Provider Name (Legal Business Name): MARIEL MILLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

106 GARDEN VIEW LN
HOOVER AL
35244-1841
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-139482
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: