Healthcare Provider Details

I. General information

NPI: 1376519355
Provider Name (Legal Business Name): CAROL ANN MILLS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6146 COTTONTAIL RD NE
RIO RANCHO NM
87144-1543
US

IV. Provider business mailing address

6146 COTTONTAIL RD NE
RIO RANCHO NM
87144-1543
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-0996
  • Fax:
Mailing address:
  • Phone: 505-249-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number255
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR14155
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: