1578718631 NPI number — JAN C. MACMILLAN RN

Table of content: JAN C. MACMILLAN RN (NPI 1578718631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578718631 NPI number — JAN C. MACMILLAN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACMILLAN
Provider First Name:
JAN
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1578718631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 E BROWN ST
Provider Second Line Business Mailing Address:
POCONO HEALTHCARE MANAGEMENT - PROFESSIONAL CENTER
Provider Business Mailing Address City Name:
EAST STROUDSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18301-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-476-3507
Provider Business Mailing Address Fax Number:
570-476-3754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 VETERANS PL
Provider Second Line Business Practice Location Address:
PMC LEARNING INSTITUTE
Provider Business Practice Location Address City Name:
STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18360-2494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-426-1688
Provider Business Practice Location Address Fax Number:
570-426-1832
Provider Enumeration Date:
11/17/2008

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: 163W00000X , with the licence number:  RN211935L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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