Healthcare Provider Details

I. General information

NPI: 1417370479
Provider Name (Legal Business Name): SELEANA MILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SELEANA MASON

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTHCREST DR
SPRINGFIELD TN
37172-3927
US

IV. Provider business mailing address

716 W BROOKHAVEN CIR
MEMPHIS TN
38117-4504
US

V. Phone/Fax

Practice location:
  • Phone: 866-362-6963
  • Fax: 866-362-4202
Mailing address:
  • Phone: 901-844-1590
  • Fax: 901-844-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN18370
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: