Provider Demographics
NPI:1093013401
Name:MILLER, DEBORAH COLLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:COLLEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13460 N PLAZA DEL RIO BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4885
Practice Address - Country:US
Practice Address - Phone:217-273-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily