Provider Demographics
NPI:1538408091
Name:MILLER, RUSSELL CHARLES (CRNA)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:CHARLES
Last Name:MILLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 S OGDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3243
Mailing Address - Country:US
Mailing Address - Phone:720-837-4701
Mailing Address - Fax:
Practice Address - Street 1:425 S CHERRY ST STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:888-209-0305
Practice Address - Fax:952-442-3620
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77654838901367500000X
TX7765483-8901367500000X
COAPN.0990790-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered