Healthcare Provider Details

I. General information

NPI: 1255771887
Provider Name (Legal Business Name): DEBORAH LYNN MILLEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HURLEY WAY #110
SACRAMENTO CA
95825-3223
US

IV. Provider business mailing address

4800 KOKOMO DR #4313
SACRAMENTO CA
95835-1820
US

V. Phone/Fax

Practice location:
  • Phone: 916-614-9539
  • Fax: 916-614-9547
Mailing address:
  • Phone: 916-425-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number779685
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number1902802
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number256102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: