Healthcare Provider Details

I. General information

NPI: 1265000376
Provider Name (Legal Business Name): MELYNDA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N HURSTBOURNE PKWY STE 200
LOUISVILLE KY
40222-5158
US

IV. Provider business mailing address

71 LINCOLN HLS
COATESVILLE IN
46121-8942
US

V. Phone/Fax

Practice location:
  • Phone: 502-907-1133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number28196388A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: