Provider Demographics
NPI:1033656095
Name:MILLER GOOD, MICHELLE JOY (RN, FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOY
Last Name:MILLER GOOD
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JOY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:808 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-7100
Mailing Address - Country:US
Mailing Address - Phone:574-534-0088
Mailing Address - Fax:
Practice Address - Street 1:808 N 3RD ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-7100
Practice Address - Country:US
Practice Address - Phone:573-534-0088
Practice Address - Fax:573-971-8434
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008886A363LF0000X, 363LF0000X
PARN618704163W00000X
DELG-0001020363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner