MEDICARE: MATTHEW A 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	RN325589	OH
2	367500000X	Certified Registered Nurse Anesthetist	D140308	IA

General Provider Information

NPI Number	:	1245549005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW A MILLER CRNA

Provider Business Mailing Address
First Line	:	407 S WHITE ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	IA
Zip	:	52641-2263
Country	:	US
Telephone Number	:	614-632-6505
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 S WHITE ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	IA
Zip	:	52641-2263
Country	:	US
Telephone Number	:	614-632-6505
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	03/25/2022

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