Healthcare Provider Details

I. General information

NPI: 1497756191
Provider Name (Legal Business Name): WENDY A MILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 ST FRANCIS BLVD SUITE 200
MIDLOTHIAN VA
23114-3206
US

IV. Provider business mailing address

1602 SKIPWITH RD
RICHMOND VA
23229-5205
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-1305
  • Fax:
Mailing address:
  • Phone: 804-289-4937
  • Fax: 804-565-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024162373
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: