Provider Demographics
NPI:1003289976
Name:MCMILLAN, DENEKA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:DENEKA
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5259 HEATHER STREET
Mailing Address - Street 2:
Mailing Address - City:HOPEMILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348
Mailing Address - Country:US
Mailing Address - Phone:910-261-2634
Mailing Address - Fax:
Practice Address - Street 1:3441 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOPEMILLS
Practice Address - State:NC
Practice Address - Zip Code:28348
Practice Address - Country:US
Practice Address - Phone:910-487-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC645161744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management