Individual
MRS. THERESA MARY MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-4274
(704) 384-5636
Mailing address
PO BOX 601549, CHARLOTTE, NC 28260-1549
(704) 384-4274
(704) 384-5636
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
077463
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052943
—
NC
05
—
NAN802
—
SC
Enumeration date
06/15/2007
Last updated
12/24/2007
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