Healthcare Provider Details

I. General information

NPI: 1659496131
Provider Name (Legal Business Name): KATHERINE MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 CECIL AVE S
MILLERSVILLE MD
21108-2111
US

IV. Provider business mailing address

1116 SPANIARDS NECK RD
CENTREVILLE MD
21617-2330
US

V. Phone/Fax

Practice location:
  • Phone: 410-923-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number21871
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: