Individual
MARISSA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 50, FORT WAYNE, IN 46845-1733
(260) 266-5400
(260) 458-8948
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71011636A
IN
Other
Enumeration date
09/01/2021
Last updated
09/25/2024
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