Provider Demographics
NPI:1093590812
Name:MACMILLAN, ERIKA (LAC, MAOM)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 BIG SPG
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4077
Mailing Address - Country:US
Mailing Address - Phone:281-770-1172
Mailing Address - Fax:
Practice Address - Street 1:4501 CARTWRIGHT RD STE 206
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3538
Practice Address - Country:US
Practice Address - Phone:281-770-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01488171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist