Provider Demographics
NPI:1104903459
Name:MILLAR, JACQUE C (NP-C)
Entity type:Individual
Prefix:
First Name:JACQUE
Middle Name:C
Last Name:MILLAR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JACQUE
Other - Middle Name:C
Other - Last Name:SNOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 UPPER FRONT ST
Mailing Address - Street 2:OCCUPATIONAL HEALTH CLINICAL CENTER
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1566
Mailing Address - Country:US
Mailing Address - Phone:607-584-9990
Mailing Address - Fax:607-584-9997
Practice Address - Street 1:840 UPPER FRONT ST
Practice Address - Street 2:OCCUPATIONAL HEALTH CLINICAL CENTER
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-1566
Practice Address - Country:US
Practice Address - Phone:607-584-9990
Practice Address - Fax:607-584-9997
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331886-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily