MEDICARE: MR. BRIAN EDWARD 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	NURA433	AK

General Provider Information

NPI Number	:	1356313985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN EDWARD MILLER CRNA

Provider Business Mailing Address
First Line	:	4300 BARTLETT ST
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-7005
Country	:	US
Telephone Number	:	907-235-0260
Fax Number	:	907-235-0289

Provider Business Practice Location Address
First Line	:	4300 BARTLETT ST
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-7005
Country	:	US
Telephone Number	:	907-235-0260
Fax Number	:	907-235-0289

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	09/03/2016

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