Provider Demographics
NPI:1649796178
Name:MILLER, ANGELA LEE (NP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 S 400 E
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-8858
Mailing Address - Country:US
Mailing Address - Phone:765-584-5720
Mailing Address - Fax:
Practice Address - Street 1:2525 W UNIVERSITY AVE STE 300
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3432
Practice Address - Country:US
Practice Address - Phone:765-281-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28164609A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner