Healthcare Provider Details

I. General information

NPI: 1205607587
Provider Name (Legal Business Name): MCCALL MILLIKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CAROLINA BAY DR STE 200
WILMINGTON NC
28403-2046
US

IV. Provider business mailing address

328 HARLANDALE DR
WILMINGTON NC
28411-9628
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-8927
  • Fax: 910-777-5031
Mailing address:
  • Phone: 843-670-9394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number239018
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: