Healthcare Provider Details

I. General information

NPI: 1164478384
Provider Name (Legal Business Name): ELIZABETH M MILLS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 W TAYLOR ST STE 101
VANDALIA IL
62471
US

IV. Provider business mailing address

PO BOX 372
MATTOON IL
61938-0372
US

V. Phone/Fax

Practice location:
  • Phone: 618-283-5136
  • Fax: 618-283-3179
Mailing address:
  • Phone: 217-258-2581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085002362
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: