MEDICARE: MRS. CARLENE S MCMILLIAN F.N.P.

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	363LF0000X	Family Nurse Practitioner	113217	MO

General Provider Information

NPI Number	:	1164427324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLENE S MCMILLIAN F.N.P.

Provider Business Mailing Address
First Line	:	P.O. DRAWER 9900
Second Line	:
City	:	DIXON
State	:	MO
Zip	:	65459-0940
Country	:	US
Telephone Number	:	573-759-3030
Fax Number	:	573-759-3131

Provider Business Practice Location Address
First Line	:	206 W. 2ND STREET
Second Line	:
City	:	DIXON
State	:	MO
Zip	:	65459-0940
Country	:	US
Telephone Number	:	573-759-3030
Fax Number	:	573-759-3131

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/06/2009

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