Basic Information
| Provider Information | |||||||||
| NPI: | 1083828602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 MANTUA PIKE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080971228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568456880 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1006 MANTUA PIKE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY HTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080971253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568456880 | ||||||||
| FaxNumber: | 8568454830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 01/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 26NN08058000 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363LX0001X | VP003422G | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.