Healthcare Provider Details

I. General information

NPI: 1518165398
Provider Name (Legal Business Name): MICHELLE MILLS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 US HIGHWAY 98 SUITE 2A
DAPHNE AL
36526
US

IV. Provider business mailing address

2868 ACTON ROAD
BIRMINGHAM AL
35243
US

V. Phone/Fax

Practice location:
  • Phone: 251-621-9167
  • Fax: 251-621-9003
Mailing address:
  • Phone: 205-968-8360
  • Fax: 205-968-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1101800
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: