Healthcare Provider Details

I. General information

NPI: 1235653908
Provider Name (Legal Business Name): AMANDA J MILEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA J BLANTON CNS

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W COLUMBIA ST STE 350
EVANSVILLE IN
47710-5610
US

IV. Provider business mailing address

PO BOX 3407
EVANSVILLE IN
47733-3407
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-7700
  • Fax: 812-450-7705
Mailing address:
  • Phone: 812-450-7700
  • Fax: 812-450-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3016827
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number71007466A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: