=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881642148
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORETTA M. MCMILLAN RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1175 N. GUIGNARD DR. SWCMHC/CAF
-----------------------------------------------------
City | SUMTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29151-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-775-7898
-----------------------------------------------------
Fax | 803-773-5246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 N. MAGNOLIA SWCMHC
-----------------------------------------------------
City | SUMTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29151-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-775-9364
-----------------------------------------------------
Fax | 803-773-6615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 36446
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------