Provider Demographics
NPI:1194130765
Name:MILLAN, AUDREY
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:MILLAN
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 1:24 BECKWITH AVE # 38
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2828
Mailing Address - Country:US
Mailing Address - Phone:973-742-3274
Mailing Address - Fax:973-742-7043
Practice Address - Street 1:24 BECKWITH AVE # 38
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2828
Practice Address - Country:US
Practice Address - Phone:973-742-3274
Practice Address - Fax:973-742-7043
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ146N00000X, 343900000X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)