Provider Demographics
NPI:1568674455
Name:MILLER, CAROL A (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 N 1000 W
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-5281
Mailing Address - Country:US
Mailing Address - Phone:812-847-4481
Mailing Address - Fax:812-847-0197
Practice Address - Street 1:1043 N 1000 W
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-5281
Practice Address - Country:US
Practice Address - Phone:812-847-4481
Practice Address - Fax:812-847-0197
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000159A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200479400Medicaid
IN547260MMMedicare PIN
IN200479400Medicaid