Provider Demographics
NPI:1316208531
Name:MCMILLAN, DIANE (CLVT, CVRT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:CLVT, CVRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-3514
Mailing Address - Country:US
Mailing Address - Phone:607-724-2428
Mailing Address - Fax:
Practice Address - Street 1:174 COURT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-3514
Practice Address - Country:US
Practice Address - Phone:607-724-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist