Individual
JOHARI NICOLE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 448-7611
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01054451A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000196762
ANTHEM PROVIDER NUMBER
IN
01
—
10825599
CAQH NUMBER
IN
05
—
200336730
—
IN
01
—
9397328
PHCS PID NUMBER
IN
Enumeration date
03/17/2006
Last updated
01/27/2021
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