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General NPI Number Information
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NPI Number | 1154183077
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Entity Type | Individual
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Provider Name | SHAUNTERREAH MILLER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 5043 E 81ST AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5912
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Country | US
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Telephone | 219-689-2573
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Fax |
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Provider Business Mailing Address
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Address Line | 605 BRANDONBURY DR
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City | VALPARAISO
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State | IN
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Zip | 46383-1408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F01240331
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License Number State | IN
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