=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215215256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER LIGGETT MCMILLIN MSN, CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2011
-----------------------------------------------------
Last Update Date | 01/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3239 STATE RD
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-2549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-923-4500
-----------------------------------------------------
Fax | 330-634-1329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3239 STATE RD
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-2549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-923-4500
-----------------------------------------------------
Fax | 330-634-1329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 12468
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------