Healthcare Provider Details

I. General information

NPI: 1174870778
Provider Name (Legal Business Name): NATHANIEL T MILLS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 JOHN DEERE RD BLDG 1
MOLINE IL
61265-6898
US

IV. Provider business mailing address

400 JOHN DEERE RD BLDG 1
MOLINE IL
61265-6898
US

V. Phone/Fax

Practice location:
  • Phone: 309-517-3036
  • Fax: 309-797-1088
Mailing address:
  • Phone: 309-517-3036
  • Fax: 309-797-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009784
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberL-114465
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: