Provider Demographics
NPI:1730805052
Name:MILLS, JESSICA JEAN (CSFA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:MILLS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 WAUSA RD
Mailing Address - Street 2:
Mailing Address - City:BOELUS
Mailing Address - State:NE
Mailing Address - Zip Code:68820-2011
Mailing Address - Country:US
Mailing Address - Phone:605-645-0123
Mailing Address - Fax:
Practice Address - Street 1:3610 RICHMOND CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3909
Practice Address - Country:US
Practice Address - Phone:308-384-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant