Healthcare Provider Details

I. General information

NPI: 1477857779
Provider Name (Legal Business Name): SHERRY LYNN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERRY LYNN OTTE CRNA

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E. LAMAR BLVD., STE. 400
ARLINGTON TX
76006
US

IV. Provider business mailing address

2000 E. LAMAR BLVD., STE. 400
ARLINGTON TX
76006
US

V. Phone/Fax

Practice location:
  • Phone: 888-804-3000
  • Fax: 817-377-0350
Mailing address:
  • Phone: 888-804-3000
  • Fax: 817-377-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number696487
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: