Healthcare Provider Details

I. General information

NPI: 1336232842
Provider Name (Legal Business Name): VANN MILLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ULUKAHIKI ST
KAILUA HI
96734-4454
US

IV. Provider business mailing address

BOX 1840
KAILUA KONA HI
96745-1840
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5500
  • Fax:
Mailing address:
  • Phone: 808-325-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN898
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: