Healthcare Provider Details

I. General information

NPI: 1609906742
Provider Name (Legal Business Name): ELIZABETH PEARL MILLS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 RIVER RD N
KEIZER OR
97303-5371
US

IV. Provider business mailing address

5100 RIVER RD N
KEIZER OR
97303-5371
US

V. Phone/Fax

Practice location:
  • Phone: 503-393-2533
  • Fax:
Mailing address:
  • Phone: 503-393-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number556451
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number201609690NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: