Provider Demographics
NPI:1922687482
Name:MILLER, DEBRA LYNN (RNFA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:KAUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:611 E DOUGLAS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1464
Mailing Address - Country:US
Mailing Address - Phone:574-968-9100
Mailing Address - Fax:574-243-1141
Practice Address - Street 1:611 E DOUGLAS RD STE 108
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1464
Practice Address - Country:US
Practice Address - Phone:574-968-9100
Practice Address - Fax:574-243-1141
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28145260A367500000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28145260AOtherINDIANA MEDICAL LICENSE