Provider Demographics
NPI:1134683717
Name:MILLS, JOLENE KELLER (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:KELLER
Last Name:MILLS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 HAYES AVE STE F
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3345
Mailing Address - Country:US
Mailing Address - Phone:419-557-6995
Mailing Address - Fax:419-627-0241
Practice Address - Street 1:1221 HAYES AVE STE F
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3345
Practice Address - Country:US
Practice Address - Phone:419-557-6995
Practice Address - Fax:419-627-0241
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.168336207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty