Healthcare Provider Details

I. General information

NPI: 1861144255
Provider Name (Legal Business Name): DAVID K MILLER RN, CDCES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 CLEARVISTA DR
INDIANAPOLIS IN
46256-1695
US

IV. Provider business mailing address

7150 CLEARVISTA DR
INDIANAPOLIS IN
46256-1695
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-2114
  • Fax:
Mailing address:
  • Phone: 317-621-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number28095096C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: