Individual
MAMTA M MILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3600 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1709
(703) 391-3129
Mailing address
PO BOX 37090, BALTIMORE, MD 21297-3090
(703) 295-9360
(703) 295-9369
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN1006629
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6236
KAISER
VA
01
—
K-142-0002
CARE FIRST
VA
Enumeration date
05/30/2008
Last updated
09/14/2011
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