Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 021158 | NY |
NPI | 1003331851 |
---|---|
Provider Name | Katie Mcmillen |
First Address | Trumansburg, NY 14886-9704 |
Second Address | Canandaigua, NY 14424-1283 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2017 |
Last Update Date | 12/08/2017 |