Healthcare Provider Details

I. General information

NPI: 1689128209
Provider Name (Legal Business Name): MARY KATHERINE MILLS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 LINCOLN DR
TEKONSHA MI
49092-9685
US

IV. Provider business mailing address

394 LINCOLN DR
TEKONSHA MI
49092-9685
US

V. Phone/Fax

Practice location:
  • Phone: 517-767-3141
  • Fax: 800-430-9616
Mailing address:
  • Phone: 517-767-3141
  • Fax: 800-430-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: