Provider Demographics
NPI:1407374218
Name:MILLETTE, JACEN PATRICK
Entity type:Individual
Prefix:
First Name:JACEN
Middle Name:PATRICK
Last Name:MILLETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 RED BARN WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45434-5650
Mailing Address - Country:US
Mailing Address - Phone:937-414-5269
Mailing Address - Fax:
Practice Address - Street 1:1441 RED BARN WAY
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434
Practice Address - Country:US
Practice Address - Phone:937-414-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program