Basic Information
| Provider Information | |||||||||
| NPI: | 1417100819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | COLLETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24138 128TH DR | ||||||||
| Address2: | |||||||||
| City: | ROSEDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114221059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182726025 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 RECTOR ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100061705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182726025 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2008 | ||||||||
| LastUpdateDate: | 10/29/2008 | ||||||||
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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 | 164W00000X | 268046-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.