Individual
MARY S MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8990 SPRINGBROOK DR NW, STE 250, COON RAPIDS, MN 55433-5850
(763) 398-0099
(763) 398-0124
Mailing address
4131 PRAIRIE RIDGE RD, EAGAN, MN 55123-1627
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 065750-5
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
087343800
—
MN
01
—
39G23MI
BCBSMN
MN
Enumeration date
08/16/2005
Last updated
05/16/2008
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