Healthcare Provider Details

I. General information

NPI: 1528038767
Provider Name (Legal Business Name): ALLEN D MILHON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E H ST
MC COOK NE
69001-3482
US

IV. Provider business mailing address

PO BOX 2307
WICHITA KS
67201-2307
US

V. Phone/Fax

Practice location:
  • Phone: 308-345-2650
  • Fax:
Mailing address:
  • Phone: 316-685-6112
  • Fax: 316-652-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100206
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: