Healthcare Provider Details

I. General information

NPI: 1891023909
Provider Name (Legal Business Name): RUSSELL A MILLER CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 MOUNTVIEW RD
COLUMBUS OH
43220-4806
US

IV. Provider business mailing address

PO BOX 21351
COLUMBUS OH
43221-0351
US

V. Phone/Fax

Practice location:
  • Phone: 614-776-4379
  • Fax: 614-569-2257
Mailing address:
  • Phone: 614-776-4379
  • Fax: 614-569-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberNS09397
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: