Provider Demographics
NPI:1194245209
Name:MILLES, CAROLYN VICTORIA (RDN, LD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:VICTORIA
Last Name:MILLES
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 QUALEY RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-7707
Mailing Address - Country:US
Mailing Address - Phone:508-965-0875
Mailing Address - Fax:
Practice Address - Street 1:510 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1339
Practice Address - Country:US
Practice Address - Phone:207-370-7787
Practice Address - Fax:844-231-8920
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU4313133V00000X
MEDI1348133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty