Individual
TERRY W MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1102 W 32ND ST, JOPLIN, MO 64804
(417) 347-1078
(417) 347-1079
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 347-1078
(417) 347-1079
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2006001065
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200075970A
—
OK
05
—
200369410A
—
KS
05
—
910527308
—
MO
01
—
P00309835
RR MEDICARE
—
Enumeration date
05/24/2006
Last updated
10/23/2007
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