Provider Demographics
NPI:1215189329
Name:MILLS, BECKI J (LPN)
Entity type:Individual
Prefix:
First Name:BECKI
Middle Name:J
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4863 STATE ROUTE 248
Mailing Address - Street 2:
Mailing Address - City:CANISTEO
Mailing Address - State:NY
Mailing Address - Zip Code:14823-9790
Mailing Address - Country:US
Mailing Address - Phone:607-698-4544
Mailing Address - Fax:585-593-3336
Practice Address - Street 1:27 RAUBER ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1512
Practice Address - Country:US
Practice Address - Phone:585-596-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281665-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse