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General NPI Number Information
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NPI Number | 1255151544
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Entity Type | Individual
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Provider Name | ASTIN MARY MILLS AG-ACNP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2024
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 25050 SE STARK ST STE 265
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City | GRESHAM
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State | OR
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Zip | 97030-3388
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Country | US
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Telephone | 503-674-1520
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Fax |
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Provider Business Mailing Address
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Address Line | 16233 S CREEK HAVEN LN
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City | BEAVERCREEK
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State | OR
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Zip | 97004-9694
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Country | US
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Telephone | 503-545-1892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 10033752
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 10033752
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License Number State | OR
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