Provider Demographics
NPI:1801101712
Name:MILLER, AMANDA NICOLE (MS , CGC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS , CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8091 TOWNSHIP LINE RD
Mailing Address - Street 2:#108
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2494
Mailing Address - Country:US
Mailing Address - Phone:317-415-9017
Mailing Address - Fax:317-415-7734
Practice Address - Street 1:8091 TOWNSHIP LINE RD
Practice Address - Street 2:#108
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2494
Practice Address - Country:US
Practice Address - Phone:317-415-9017
Practice Address - Fax:317-415-7734
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN74000014A170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS