Healthcare Provider Details

I. General information

NPI: 1447185723
Provider Name (Legal Business Name): JAVONNA LANA MCMILLIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 WETZLER RD
TOLEDO OH
43612-1642
US

IV. Provider business mailing address

4035 WETZLER RD
TOLEDO OH
43612-1642
US

V. Phone/Fax

Practice location:
  • Phone: 419-215-1196
  • Fax:
Mailing address:
  • Phone: 419-215-1196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number4807472
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: