Provider Demographics
NPI:1962150748
Name:MIDDELER, JEANNA RAE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:RAE
Last Name:MIDDELER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-2036
Mailing Address - Country:US
Mailing Address - Phone:812-767-2371
Mailing Address - Fax:
Practice Address - Street 1:711 GREEN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2143
Practice Address - Country:US
Practice Address - Phone:812-767-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011895A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health