Provider Demographics
NPI:1386934040
Name:MILLS, SALLY ANN (PNP)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:MILLS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ANN
Other - Last Name:CHIADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3333 BURNET AVE # MLC2003
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-9985
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNET AVE # ML2003
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4432
Practice Address - Fax:513-636-3952
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12189363L00000X
OHAPRN.CNP12189363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089935Medicaid
OHH244290Medicare PIN