Provider Demographics
NPI:1992744130
Name:MILLAR, JUDITH M (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:MILLAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:2 BLACKBURN DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2227
Mailing Address - Country:US
Mailing Address - Phone:978-281-1500
Mailing Address - Fax:978-282-3699
Practice Address - Street 1:1 BLACKBURN DR STE 1
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2293
Practice Address - Country:US
Practice Address - Phone:978-281-1500
Practice Address - Fax:978-282-3699
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA176172363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP0052Medicare ID - Type Unspecified
MA509484Medicare UPIN