Healthcare Provider Details

I. General information

NPI: 1275465718
Provider Name (Legal Business Name): SHADRIAN MILLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27717 NE 150TH ST
DUVALL WA
98019-8561
US

IV. Provider business mailing address

27717 NE 150TH ST
DUVALL WA
98019-8561
US

V. Phone/Fax

Practice location:
  • Phone: 425-405-2303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN70002935
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: