Provider Demographics
NPI:1548981186
Name:MCMILLEN, AMY L (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:MCMILLEN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:SIEBENMORGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:6334 IDA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-1019
Mailing Address - Country:US
Mailing Address - Phone:719-679-7944
Mailing Address - Fax:
Practice Address - Street 1:6334 IDA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-1019
Practice Address - Country:US
Practice Address - Phone:719-679-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86076733133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered