Provider Demographics
NPI:1063479913
Name:MILLS, ADA ELAINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:ELAINE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 STATE ROUTE 335
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-9038
Mailing Address - Country:US
Mailing Address - Phone:740-776-4249
Mailing Address - Fax:
Practice Address - Street 1:2385 STATE ROUTE 335
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-9038
Practice Address - Country:US
Practice Address - Phone:740-776-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-096794164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2388821Medicaid