Healthcare Provider Details

I. General information

NPI: 1639918071
Provider Name (Legal Business Name): ELISE MILLS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E 2ND ST
LIBBY MT
59923-2047
US

IV. Provider business mailing address

193 E COMMERCE WAY UNIT 8
LIBBY MT
59923-1649
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-8711
  • Fax:
Mailing address:
  • Phone: 317-525-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: