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NPI Code Detail

MEDICARE: MONICA MILLS STICKFORT DO

MEDICARE: MONICA MILLS STICKFORT DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine PhysicianDO204475OR

General Provider Information

NPI Number : 1336644210
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA MILLS STICKFORT DO
Provider Business Mailing Address
First Line : 1200 NW 23RD AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97210-2906
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1200 NW 23RD AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97210-2906
Country : US
Telephone Number : 503-413-7074
Fax Number : 503-413-6892
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2018
Last Update Date : 01/08/2026

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Directions to “ MONICA MILLS STICKFORT DO” Practice Location

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