Healthcare Provider Details

I. General information

NPI: 1932630407
Provider Name (Legal Business Name): LESLIE ANN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE ANN SAUNDERS RN

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 AVENUE B
SCOTTSBLUFF NE
69361-4602
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-3711
  • Fax:
Mailing address:
  • Phone: 970-518-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP137760
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101392
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: