Provider Demographics
NPI:1487448791
Name:MCMILLAN- ROZARIO, MINTZELLA
Entity type:Individual
Prefix:
First Name:MINTZELLA
Middle Name:
Last Name:MCMILLAN- ROZARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 KEMPTON RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1102
Mailing Address - Country:US
Mailing Address - Phone:301-509-7636
Mailing Address - Fax:
Practice Address - Street 1:6301 WALKER MILL RD
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-4328
Practice Address - Country:US
Practice Address - Phone:301-516-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP29073164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse