Healthcare Provider Details

I. General information

NPI: 1114341807
Provider Name (Legal Business Name): LAURA JEAN MILLS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

30557 E POINTE DR
GIBRALTAR MI
48173-9587
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-7500
  • Fax:
Mailing address:
  • Phone: 734-301-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704257989
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: