Provider Demographics
NPI:1215180161
Name:MILLS, LISA RENEE (RNNPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:MILLS
Suffix:
Gender:F
Credentials:RNNPC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:KUNTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNNPC
Mailing Address - Street 1:215 SOUTH BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3479
Mailing Address - Country:US
Mailing Address - Phone:856-459-8237
Mailing Address - Fax:
Practice Address - Street 1:215 S BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3479
Practice Address - Country:US
Practice Address - Phone:856-459-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08208400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health