Healthcare Provider Details

I. General information

NPI: 1598208878
Provider Name (Legal Business Name): ELIZABETH MCMILLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 4TH STREET BOX 4002
SAN FRANCISCO CA
94143-4002
US

IV. Provider business mailing address

1855 4TH STREET BOX 4002
SAN FRANCISCO CA
94143-4002
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number912493
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: