Provider Demographics
NPI:1063442374
Name:MCMILLAN, E BROOKS (NP)
Entity type:Individual
Prefix:
First Name:E
Middle Name:BROOKS
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11648
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5648
Mailing Address - Country:US
Mailing Address - Phone:360-683-8544
Mailing Address - Fax:360-683-8545
Practice Address - Street 1:512 EAST WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-683-8544
Practice Address - Fax:360-683-8545
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000992174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP15401Medicare UPIN