Individual
MR. JOSEPH JERALD MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0449
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041378411
IL
163W00000X
Registered Nurse
180592
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
209012463
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
GROUP PTAN
IL
Enumeration date
12/23/2014
Last updated
09/27/2021
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