Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN263864 | GA |
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN263864 | GA |
NPI | 1013684984 |
---|---|
Provider Name | Jena Millwood |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-3806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2021 |
Last Update Date | 08/12/2021 |