Provider Demographics
NPI:1154124337
Name:MCMILLAN, MONIQUE M (NUTRITIONISTS)
Entity type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:M
Last Name:MCMILLAN
Suffix:
Gender:
Credentials:NUTRITIONISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13311 AUGUST DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-8595
Mailing Address - Country:US
Mailing Address - Phone:251-382-8122
Mailing Address - Fax:
Practice Address - Street 1:1303 DR MARTIN L KING JR AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5341
Practice Address - Country:US
Practice Address - Phone:251-432-4117
Practice Address - Fax:251-436-7765
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5065133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist