Provider Demographics
NPI:1215696083
Name:MILLS, MIRIAM (BED)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:BED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26110 BASIL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1252
Mailing Address - Country:US
Mailing Address - Phone:713-855-2143
Mailing Address - Fax:
Practice Address - Street 1:26110 BASIL VIEW LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1252
Practice Address - Country:US
Practice Address - Phone:713-855-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date: