Provider Demographics
NPI:1699054833
Name:MILLER, LUCINDA SUE (RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9608 N CRAWFORD STREET
Mailing Address - Street 2:
Mailing Address - City:KNIGHTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47857
Mailing Address - Country:US
Mailing Address - Phone:317-509-4018
Mailing Address - Fax:
Practice Address - Street 1:9608 NORTH CRAWFORD STREET
Practice Address - Street 2:
Practice Address - City:KNIGHTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47857
Practice Address - Country:US
Practice Address - Phone:317-509-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37000533A133V00000X
14212133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered