Provider Demographics
NPI:1407239569
Name:MILLER, EMILY JO (NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11495 N PENN ST
Mailing Address - Street 2:STE 270
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5636
Mailing Address - Country:US
Mailing Address - Phone:317-938-4559
Mailing Address - Fax:317-343-0336
Practice Address - Street 1:11495 N PENN ST
Practice Address - Street 2:STE 270
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5636
Practice Address - Country:US
Practice Address - Phone:317-938-4559
Practice Address - Fax:317-343-0336
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28167650A163W00000X
IN71005643A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01588249OtherRR MEDICARE
IN201309280Medicaid
INP01588249OtherRR MEDICARE