Healthcare Provider Details

I. General information

NPI: 1487894564
Provider Name (Legal Business Name): JANICE MIILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E THOMAS RD
PHOENIX AZ
85016-7711
US

IV. Provider business mailing address

8144 E CACTUS RD SUITE 800
SCOTTSDALE AZ
85260-5266
US

V. Phone/Fax

Practice location:
  • Phone: 602-532-2160
  • Fax:
Mailing address:
  • Phone: 480-596-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0616
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: