Provider Demographics
NPI:1093105652
Name:MILLMAN, MISTY J (RN)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:J
Last Name:MILLMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220
Mailing Address - Country:US
Mailing Address - Phone:575-234-3320
Mailing Address - Fax:
Practice Address - Street 1:406 N ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220
Practice Address - Country:US
Practice Address - Phone:575-234-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR57777163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool