Provider Demographics
NPI:1104570043
Name:MCMILLIN, MARY (NP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7432 N VIA CAMELLO DEL NORTE UNIT 176
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3645
Mailing Address - Country:US
Mailing Address - Phone:602-999-5847
Mailing Address - Fax:
Practice Address - Street 1:11000 N SCOTTSDALE RD STE 160
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5269
Practice Address - Country:US
Practice Address - Phone:623-401-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN109461163W00000X
KS53-80957-071363LF0000X
AZ271697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse