Healthcare Provider Details

I. General information

NPI: 1013944669
Provider Name (Legal Business Name): SUZANNA P. MILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 MILLBURN AVE
MILLBURN NJ
07041-1847
US

IV. Provider business mailing address

187 MILLBURN AVE SUITE 101
MILLBURN NJ
07041-1847
US

V. Phone/Fax

Practice location:
  • Phone: 973-467-1466
  • Fax: 973-467-1422
Mailing address:
  • Phone: 973-467-1466
  • Fax: 973-467-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200360053CRNA
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00388600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: