Basic Information
| Provider Information | |||||||||
| NPI: | 1336257476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1213 GARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | HARLAN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515372057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127555161 | ||||||||
| FaxNumber: | 7127554312 | ||||||||
| Practice Location | |||||||||
| Address1: | 1213 GARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | HARLAN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515372057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127554349 | ||||||||
| FaxNumber: | 7127554290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 08/14/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 038240 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 2234534 | 05 | IA | MEDICAID |