Healthcare Provider Details

I. General information

NPI: 1912083007
Provider Name (Legal Business Name): TONI ELLEN MILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHINGTON ST
MEDINA OH
44256-2170
US

IV. Provider business mailing address

4049 HARDING DR
WESTLAKE OH
44145-5315
US

V. Phone/Fax

Practice location:
  • Phone: 800-381-7246
  • Fax:
Mailing address:
  • Phone: 440-871-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN132023
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: