Healthcare Provider Details

I. General information

NPI: 1275351066
Provider Name (Legal Business Name): ANNELISE MILLAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67555 E PALM CANYON DR STE C112
CATHEDRAL CITY CA
92234-5412
US

IV. Provider business mailing address

67555 E PALM CANYON DR STE C112
CATHEDRAL CITY CA
92234-5412
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-1680
  • Fax: 760-773-3144
Mailing address:
  • Phone: 760-773-1680
  • Fax: 760-773-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: