Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 01059206 | IN |
N | 207RX0202X | Medical Oncology | 01059206 | IN |
NPI | 1114926060 |
---|---|
Provider Name | Mrs. Jenelle S Miller |
First Address | Atlanta, GA 30368-7287 |
Second Address | Indianapolis, IN 46260-2081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 02/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200497270 | (05) | IN |
I16458 | (02) |