Healthcare Provider Details

I. General information

NPI: 1255615597
Provider Name (Legal Business Name): ANDREA M MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 N 1ST ST
VINCENNES IN
47591-1340
US

IV. Provider business mailing address

1160E SAINT CLAIR ST
VINCENNES IN
47591-4853
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-4694
  • Fax: 812-882-0630
Mailing address:
  • Phone: 812-885-0680
  • Fax: 812-882-0630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003709A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: