MEDICARE: MONICA Y MILLS FNP

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	2001021212	MO

General Provider Information

NPI Number	:	1457663312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA Y MILLS FNP

Provider Business Mailing Address
First Line	:	670 MASON RIDGE CENTER DR
Second Line	:	SUITE 300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8573
Country	:	US
Telephone Number	:	314-996-7644
Fax Number	:	314-996-7658

Provider Business Practice Location Address
First Line	:	11133 DUNN RD
Second Line	:	ROOM 2235
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6119
Country	:	US
Telephone Number	:	314-653-5643
Fax Number	:	314-653-5648

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	06/23/2014

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