Provider Demographics
NPI:1114321528
Name:MCMILLAN, AMANDA (CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:FLANDREAU
Mailing Address - State:SD
Mailing Address - Zip Code:57028-1529
Mailing Address - Country:US
Mailing Address - Phone:605-997-2642
Mailing Address - Fax:605-997-9940
Practice Address - Street 1:701 W BROAD AVE
Practice Address - Street 2:
Practice Address - City:FLANDREAU
Practice Address - State:SD
Practice Address - Zip Code:57028-1529
Practice Address - Country:US
Practice Address - Phone:605-997-2642
Practice Address - Fax:605-997-9940
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily