Basic Information
| Provider Information | |||||||||
| NPI: | 1104392281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | IRYNA | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | AGACNP-BC, CCRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 793 W STATE ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432221551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142345000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 OLENTANGY RIVER RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432021523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147545500 | ||||||||
| FaxNumber: | 6147545501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2018 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 023139 | OH | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 363LA2100X | APRN.CNP.023139 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 0322961 | 05 | OH | MEDICAID |