Provider Demographics
NPI:1386910099
Name:MILLS, MARY JANE DEMELLO (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:DEMELLO
Last Name:MILLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WOLF POND RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-2187
Mailing Address - Country:US
Mailing Address - Phone:781-632-7073
Mailing Address - Fax:781-585-0194
Practice Address - Street 1:121 WOLF POND RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-2187
Practice Address - Country:US
Practice Address - Phone:781-632-7073
Practice Address - Fax:781-585-0194
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133429163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse