Basic Information
| Provider Information | |||||||||
| NPI: | 1568674455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1043 N 1000 W | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474415281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128474481 | ||||||||
| FaxNumber: | 8128470197 | ||||||||
| Practice Location | |||||||||
| Address1: | 1043 N 1000 W | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474415281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128474481 | ||||||||
| FaxNumber: | 8128470197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 09/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 71000159A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 200479400 | 05 | IN | MEDICAID |