Healthcare Provider Details

I. General information

NPI: 1053614693
Provider Name (Legal Business Name): ABBEY MILLI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBEY D HENDRIXSON NP

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 STATESMEN DR STE A
INDIANAPOLIS IN
46250-5649
US

IV. Provider business mailing address

4745 STATESMEN DR STE A
INDIANAPOLIS IN
46250-5649
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-2990
  • Fax:
Mailing address:
  • Phone: 317-844-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71003517A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28167231A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003517A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: