1518967058 NPI number — MRS. DAWN C MILLS ANP

Table of content: MRS. DAWN C MILLS ANP (NPI 1518967058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518967058 NPI number — MRS. DAWN C MILLS ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLS
Provider First Name:
DAWN
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518967058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 NNPTC CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOOSE CREEK
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29445-6314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-577-5011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 TRICOM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-797-1770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  1416 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 54 60206 . This is a "STATE REGISTRATION NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1416 . This is a "APRN LISENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 571134452 . This is a "FEDERAL ID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: NP0665 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP3438 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98466 . This is a "SC PCF" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: JBM01311 . This is a "JUA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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