Basic Information
Provider Information
NPI: 1003001041
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: KATHLEEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2800 PATTERSON DR
Address2:  
City: ALIQUIPPA
State: PA
PostalCode: 150011129
CountryCode: US
TelephoneNumber: 7243751919
FaxNumber:  
Practice Location
Address1: 1000 DUTCH RIDGE RD
Address2:  
City: BEAVER
State: PA
PostalCode: 150099727
CountryCode: US
TelephoneNumber: 7247734621
FaxNumber: 7247734696
Other Information
ProviderEnumerationDate: 09/12/2007
LastUpdateDate: 09/12/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XRN522303LPAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
RN522303L01PARN LICENSEOTHER


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