Provider Demographics
NPI:1962950113
Name:MILLER, MARCELLA IRENE (RN, MS(ED) FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:IRENE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, MS(ED) FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-5236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 MEDICAL CENTRE DR STE C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4758
Practice Address - Country:US
Practice Address - Phone:817-461-0201
Practice Address - Fax:817-861-3365
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058064363L00000X, 363LA2100X
IN71006614A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner