Healthcare Provider Details

I. General information

NPI: 1558686766
Provider Name (Legal Business Name): TODD K. MILLER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVE SUITE 800
SEATTLE WA
98104-3595
US

IV. Provider business mailing address

901 BOREN AVE SUITE 800
SEATTLE WA
98104-3595
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-1900
  • Fax: 206-709-0148
Mailing address:
  • Phone: 206-323-1900
  • Fax: 206-709-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00146590
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: