Individual
JADE MARIE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
2121 LAKE AVENUE, FORT WAYNE, IN 46805
(260) 426-5431
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F0914352
IN
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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