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Individual

MICHAEL RANDALL MILLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 318-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
43617
ID

Other

Enumeration date
03/01/2018
Last updated
03/01/2018
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