Healthcare Provider Details

I. General information

NPI: 1942245071
Provider Name (Legal Business Name): CHRISTOPHER MILLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LANE MEDICAL ASSOCIATES LLP
PIERRE SD
57501
US

IV. Provider business mailing address

100 MAC LANE MEDICAL ASSOCIATES LLP
PIERRE SD
57501
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-5901
  • Fax: 605-645-5296
Mailing address:
  • Phone: 605-224-5901
  • Fax: 605-645-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number052280
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: