Provider Demographics
NPI:1992703375
Name:MILLSPAW, JOYCE R (PHD, FNP,WHNP, HHNP)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:R
Last Name:MILLSPAW
Suffix:
Gender:F
Credentials:PHD, FNP,WHNP, HHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 PONTIAC ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3382
Mailing Address - Country:US
Mailing Address - Phone:209-847-7759
Mailing Address - Fax:209-848-0732
Practice Address - Street 1:190 S OAK AVE
Practice Address - Street 2:BLDG1 STE 4
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3528
Practice Address - Country:US
Practice Address - Phone:209-848-8410
Practice Address - Fax:209-848-0732
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 2597/322954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
R22595Medicare UPIN
CA053971AMedicare ID - Type Unspecified