Healthcare Provider Details

I. General information

NPI: 1700519675
Provider Name (Legal Business Name): MEGHAN E. MIILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGHAN E GLEASON NP

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

PO BOX 778912
CHICAGO IL
60677-8912
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-4779
  • Fax: 317-948-9806
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number28237060A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number363LN0000X
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number71012625A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: