Healthcare Provider Details

I. General information

NPI: 1073943064
Provider Name (Legal Business Name): DANA MILLER AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD SUITE G600
KANSAS CITY KS
66103-2937
US

IV. Provider business mailing address

3901 RAINBOW BLVD SUITE G600
KANSAS CITY KS
66103-2937
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-9600
  • Fax: 913-588-9220
Mailing address:
  • Phone: 913-588-9600
  • Fax: 913-588-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberKS5376156111
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberKS5374433111
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2013038958
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: