Healthcare Provider Details

I. General information

NPI: 1083828602
Provider Name (Legal Business Name): MELISSA L MILLS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 MANTUA PIKE
WOODBURY HTS NJ
08097-1253
US

IV. Provider business mailing address

1006 MANTUA PIKE
WOODBURY NJ
08097-1228
US

V. Phone/Fax

Practice location:
  • Phone: 856-845-6880
  • Fax: 856-845-4830
Mailing address:
  • Phone: 856-845-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number26NN08058000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberVP003422G
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: