Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 01073259A | IN |
Y | 207Q00000X | Family Doctor | 01073259A | IN |
NPI | 1013283464 |
---|---|
Provider Name | Milissa Ann Eley |
First Address | Muncie, IN 47303-4988 |
Second Address | Muncie, IN 47305-2465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2012 |
Last Update Date | 30/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201095600 | (05) | IN |