MEDICARE: AGNES MARIE MILLER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	COA.00057-NA	OH

General Provider Information

NPI Number	:	1235170846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNES MARIE MILLER CRNA

Provider Business Mailing Address
First Line	:	50 N PLAZA BLVD
Second Line	:
City	:	CHILLICOTHEE
State	:	OH
Zip	:	45601-1757
Country	:	US
Telephone Number	:	866-587-8790
Fax Number	:	740-774-4061

Provider Business Practice Location Address
First Line	:	210 SHARON RD
Second Line	:
City	:	CIRCLEVILLE
State	:	OH
Zip	:	43113-1498
Country	:	US
Telephone Number	:	866-587-8790
Fax Number	:	740-774-4061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/08/2007

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