Healthcare Provider Details

I. General information

NPI: 1881642148
Provider Name (Legal Business Name): LORETTA M. MCMILLAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 N. GUIGNARD DR. SWCMHC/CAF
SUMTER SC
29151-1946
US

IV. Provider business mailing address

215 N. MAGNOLIA SWCMHC
SUMTER SC
29151-1946
US

V. Phone/Fax

Practice location:
  • Phone: 803-775-7898
  • Fax: 803-773-5246
Mailing address:
  • Phone: 803-775-9364
  • Fax: 803-773-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number36446
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: