Provider Demographics
NPI:1295186914
Name:MILLS, TAJUANNA DEANNE
Entity Type:Individual
Prefix:
First Name:TAJUANNA
Middle Name:DEANNE
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 WOODBINE AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4961
Mailing Address - Country:US
Mailing Address - Phone:330-246-0924
Mailing Address - Fax:
Practice Address - Street 1:1578 WOODBINE AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4961
Practice Address - Country:US
Practice Address - Phone:330-246-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS184881374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide