Basic Information
| Provider Information | |||||||||
| NPI: | 1528715356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLINER | ||||||||
| FirstName: | EVENNY | ||||||||
| MiddleName: | NISHIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 WATERSIDE CT | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208743741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743861872 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 N HOWARD ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212185909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434386742 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2022 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 27917 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.