Provider Demographics
NPI:1083828602
Name:MILLS, MELISSA L (CRNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:MILLS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1228
Mailing Address - Country:US
Mailing Address - Phone:856-845-6880
Mailing Address - Fax:
Practice Address - Street 1:1006 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY HTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1253
Practice Address - Country:US
Practice Address - Phone:856-845-6880
Practice Address - Fax:856-845-4830
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08058000363LX0001X
PAVP003422G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology