Provider Demographics
NPI:1760881262
Name:MILES, NICHELLE
Entity Type:Individual
Prefix:
First Name:NICHELLE
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8645 LIGHTHORSE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231-2523
Mailing Address - Country:US
Mailing Address - Phone:317-260-6096
Mailing Address - Fax:317-241-2177
Practice Address - Street 1:8645 LIGHTHORSE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-2523
Practice Address - Country:US
Practice Address - Phone:317-260-6096
Practice Address - Fax:317-241-2177
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker