Provider Demographics
NPI:1104240274
Name:MILLS, RESHATA
Entity type:Individual
Prefix:
First Name:RESHATA
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:
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 41114
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-0514
Mailing Address - Country:US
Mailing Address - Phone:302-363-4451
Mailing Address - Fax:
Practice Address - Street 1:4 ATLANTIC ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2350
Practice Address - Country:US
Practice Address - Phone:202-540-9857
Practice Address - Fax:202-232-8494
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
VA0024171342363L00000X
DCRN1027098363L00000X, 176B00000X
MDR219629363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner