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General NPI Number Information
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NPI Number | 1932574670
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Entity Type | Individual
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Provider Name | GAYLE MILLIS LPN
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Gender | Female
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 3260 E CAROLLTON DR
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City | OAK CREEK
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State | WI
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Zip | 53154-4165
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Country | US
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Telephone | 262-989-2366
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Fax | 414-304-5866
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Provider Business Mailing Address
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Address Line | 3260 E CAROLLTON DR
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City | OAK CREEK
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State | WI
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Zip | 53154-4165
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Country | US
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Telephone | 262-989-2366
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Fax | 414-304-5866
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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 | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 0013030
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 0015707
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 0014938
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 0013357
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 0015444
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License Number State | WI
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Taxonomy #6
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 0014242
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License Number State | WI
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