Provider Demographics
NPI:1730698267
Name:LOOP-MILLER, JENNIFER JEAN (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JEAN
Last Name:LOOP-MILLER
Suffix:
Gender:F
Credentials:PMHNP
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Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 N MICHIGAN ST STE 400
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1071
Practice Address - Country:US
Practice Address - Phone:574-647-8470
Practice Address - Fax:574-647-8524
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2023-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71007555A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health