Healthcare Provider Details

I. General information

NPI: 1235170846
Provider Name (Legal Business Name): AGNES MARIE MILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SHARON RD
CIRCLEVILLE OH
43113-1498
US

IV. Provider business mailing address

50 N PLAZA BLVD
CHILLICOTHEE OH
45601-1757
US

V. Phone/Fax

Practice location:
  • Phone: 866-587-8790
  • Fax: 740-774-4061
Mailing address:
  • Phone: 866-587-8790
  • Fax: 740-774-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.00057-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: