Individual
MIA NISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10865 MAPLE LN STE B, SAINT JOHN, IN 46373-8660
(219) 365-8546
Mailing address
7241 E 104TH PL, CROWN POINT, IN 46307-7685
(219) 444-5225
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041510100
IL
163W00000X
Registered Nurse
Primary
RN9557804
FL
Other
Enumeration date
06/20/2026
Last updated
06/20/2026
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