Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71003517A | IN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 71003517A | IN |
NPI | 1053614693 |
---|---|
Provider Name | Abbey Milli |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Indianapolis, IN 46250-3648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2010 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201009310 | (05) | IN |
P01291597 | MEDICARE RR PTAN (01) | IN |