| Doctor Name: | MR. ETTHAN CHARLES MILLER |
| NPI Number: | 1336546209 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 0001111520 |
| Business Practice Address: | 1785 W Lee Hwy Wytheville, VA - 243821437 |
| Business Phone Number: | 2766204246 |
| Business Fax Number: | |
| Mailing Address: | 1785 W Lee Hwy, P.o. Box 662 WYTHEVILLE |
| State: | VA |
| Postal Code: | 243821437 |
| Phone Number: | 2762286499 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2014 |
| NPI Last Update Date: | 01/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WE0003X |
| License Number: | 0001111520 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Emergency |
| Taxonomy Definition: | |