Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D13660 | MN |
NPI | 1003263377 |
---|---|
Provider Name | Dr. Allison Marie Mcmillen |
First Address | Blaine, MN 55434-4147 |
Second Address | Blaine, MN 55434-4147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2016 |
Last Update Date | 17/05/2016 |