Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | TAP7569 | AZ |
NPI | 1023249877 |
---|---|
Provider Name | Jessica M Mills |
First Address | Flagstaff, AZ 86004-6121 |
Second Address | Flagstaff, AZ 86004-6121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 16/01/2015 |