Healthcare Provider Details

I. General information

NPI: 1326357385
Provider Name (Legal Business Name): VERN HANSEN MILLER MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 LOCUST LN STE 202
HARRISBURG PA
17109-4444
US

IV. Provider business mailing address

8 E MAIN ST APT. 1
SHIREMANSTOWN PA
17011-6426
US

V. Phone/Fax

Practice location:
  • Phone: 717-526-2111
  • Fax: 717-526-2117
Mailing address:
  • Phone: 724-421-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09578
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: