Healthcare Provider Details

I. General information

NPI: 1528296274
Provider Name (Legal Business Name): LADONNA ANN MILLER CST/CSFA, KCSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 KENTUCKY AVE DOCTOR'S BUILDING 1, SUITE 103
PADUCAH KY
42003-3817
US

IV. Provider business mailing address

2707 MADISON ST
PADUCAH KY
42001-3733
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-9199
  • Fax:
Mailing address:
  • Phone: 270-217-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number106545
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: