MEDICARE: CRYSTAL RAE MILLER RN

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	163WX0106X	Occupational Health Registered Nurse	28234055A	IN
2	163WX0106X	Occupational Health Registered Nurse	428488	OH
3	163WX0106X	Occupational Health Registered Nurse	201606965RN	OR
4	163WX0106X	Occupational Health Registered Nurse	RN60661271	WA
5	163WX0106X	Occupational Health Registered Nurse	14-137347-012	KS
6	163WX0106X	Occupational Health Registered Nurse	RN152873	LA
7	163WX0106X	Occupational Health Registered Nurse	95046558	CA
8	163WX0106X	Occupational Health Registered Nurse	RN689954	PA
9	163WX0106X	Occupational Health Registered Nurse	41423593	IL
10	163WX0106X	Occupational Health Registered Nurse	26NR17735300	NJ
11	163WX0106X	Occupational Health Registered Nurse	RN9403347	FL
12	163WX0106X	Occupational Health Registered Nurse	1-158440	AL
13	163WX0106X	Occupational Health Registered Nurse	RN247378	GA
14	163WX0106X	Occupational Health Registered Nurse	RN77665	HI
15	163WX0106X	Occupational Health Registered Nurse	5473244-3102	UT

General Provider Information

NPI Number	:	1467966234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL RAE MILLER RN

Provider Business Mailing Address
First Line	:	2396 S 300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2396 S 300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2853
Country	:	US
Telephone Number	:	562-355-5276
Fax Number	:

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

Provider Enumeration Date	:	11/30/2017
Last Update Date	:	11/30/2017

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