Individual
LARRY STEVEN MCMILLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
933 SELLS AVE, CANON CITY, CO 81212-4900
(719) 275-6433
Mailing address
8022 GARDEN PARK RD, CANON CITY, CO 81212-9639
(719) 276-2029
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
45130
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25034022
—
CO
Enumeration date
06/26/2006
Last updated
07/08/2007
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