Healthcare Provider Details

I. General information

NPI: 1447559786
Provider Name (Legal Business Name): KATHRINE ANNETTE MILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N MADISON AVE
ANDERSON IN
46011
US

IV. Provider business mailing address

8051 S EMERSON AVE STE 200
INDIANAPOLIS IN
46237-8632
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-2928
  • Fax:
Mailing address:
  • Phone: 317-865-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209008642
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28208434A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.12151-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: