Healthcare Provider Details

I. General information

NPI: 1881624229
Provider Name (Legal Business Name): ROBERT EDWARD MILLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL DRIVE S.E.
HUNTSVILLE AL
35801
US

IV. Provider business mailing address

53 COUNTY RD 1500
CULLMAN AL
35058
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-4186
  • Fax:
Mailing address:
  • Phone: 256-739-1052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-015359
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: