MEDICARE: MARY MCMILLIN NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN109461	AZ
2	363LF0000X	Family Nurse Practitioner	53-80957-071	KS
3	363LF0000X	Family Nurse Practitioner	271697	AZ

General Provider Information

NPI Number	:	1104570043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MCMILLIN NP-C

Provider Business Mailing Address
First Line	:	7432 N VIA CAMELLO DEL NORTE UNIT 176
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3645
Country	:	US
Telephone Number	:	602-999-5847
Fax Number	:

Provider Business Practice Location Address
First Line	:	11000 N SCOTTSDALE RD STE 160
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-5269
Country	:	US
Telephone Number	:	623-401-7546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	11/27/2024

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