Healthcare Provider Details

I. General information

NPI: 1679221329
Provider Name (Legal Business Name): IVY SMITH MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IVY SMITH BECKFORD RN

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GREENBELT RD STE L5
BERWYN HEIGHTS MD
20740-2357
US

IV. Provider business mailing address

8502 RHEIMS CT
UPPER MARLBORO MD
20772-6404
US

V. Phone/Fax

Practice location:
  • Phone: 571-926-2760
  • Fax:
Mailing address:
  • Phone: 443-518-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR144184
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: