Individual
KRISTA L. MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
311 W LINCOLN ST STE 101, BELLEVILLE, IL 62220-1902
(618) 222-3200
(618) 222-3203
Mailing address
311 W LINCOLN ST STE 101, BELLEVILLE, IL 62220-1902
(182) 223-2006
(618) 222-3203
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209.011240
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209011240
—
IL
Enumeration date
02/19/2014
Last updated
05/09/2018
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