Provider Demographics
NPI:1225345770
Name:MILLS, TRACI ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:ANN
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TRACI
Other - Middle Name:ANN
Other - Last Name:UPCHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3915 VERNA DR
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9566
Mailing Address - Country:US
Mailing Address - Phone:419-283-0771
Mailing Address - Fax:
Practice Address - Street 1:3915 VERNA DR
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9566
Practice Address - Country:US
Practice Address - Phone:419-283-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-04
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.140234164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse