Provider Demographics
NPI:1730277021
Name:MILLER, MARK FRANK (CRNA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:FRANK
Last Name:MILLER
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1221 SW CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3254
Mailing Address - Country:US
Mailing Address - Phone:816-347-0088
Mailing Address - Fax:816-347-0088
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-404-1100
Practice Address - Fax:816-404-1103
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO133958367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO913766002Medicaid