Provider Demographics
NPI:1285650036
Name:MILLER, RANDEE (MSN APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:RANDEE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSN APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 NAAB ROAD
Mailing Address - Street 2:SUITE 3P
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1975
Mailing Address - Country:US
Mailing Address - Phone:317-608-6090
Mailing Address - Fax:317-876-1971
Practice Address - Street 1:8424 NAAB ROAD
Practice Address - Street 2:SUITE 3P
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1975
Practice Address - Country:US
Practice Address - Phone:317-608-6090
Practice Address - Fax:317-876-1971
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001160A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN266290AMedicare PIN