Individual
MRS. LYNN MARIE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(260) 266-7368
Mailing address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(260) 370-1241
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002760A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2543-5138
EMERGENCY FIRST RESPONDER
IN
Enumeration date
11/01/2018
Last updated
12/04/2024
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