1376619882 NPI number — MS. SUSAN K MILLER CRNA

Table of content: MS. SUSAN K MILLER CRNA (NPI 1376619882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376619882 NPI number — MS. SUSAN K MILLER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
SUSAN
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376619882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5175 W WOODLAWN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNNELLON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34433-2660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-465-0141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5175 W WOODLAWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNNELLON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34433-2660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-465-0141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ARNP2140782 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: ARNP21407822 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N146227 . This is a "HTHEZ" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G1271 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 300884300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ARNP2140782 . This is a "W C" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 592689712 . This is a "UHC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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