Provider Demographics
NPI:1235189200
Name:MILLS, JERI (MD)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2963
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80539-2963
Mailing Address - Country:US
Mailing Address - Phone:970-962-0058
Mailing Address - Fax:
Practice Address - Street 1:20 5TH ST SE
Practice Address - Street 2:
Practice Address - City:COOK
Practice Address - State:MN
Practice Address - Zip Code:55723-9702
Practice Address - Country:US
Practice Address - Phone:218-666-5941
Practice Address - Fax:218-666-5099
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21190207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN47543OtherMEDICAL LICENSE
AS21190OtherMEDICAL LICENSE
CO44076OtherMEDICAL LICENSE
BM9121548OtherDEA NUMBER
AS21190OtherMEDICAL LICENSE