Provider Demographics
NPI:1255688040
Name:MCMILLIAN, AMANDA (RN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 MARTIN LUTHER KING JR WAY S STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2183
Mailing Address - Country:US
Mailing Address - Phone:206-320-5325
Mailing Address - Fax:206-320-5326
Practice Address - Street 1:4515 MARTIN LUTHER KING JR WAY S STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2183
Practice Address - Country:US
Practice Address - Phone:206-320-5325
Practice Address - Fax:206-320-5326
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60063616163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse