Provider Demographics
NPI:1326421819
Name:MCMILLAN, KINDA CAMILLE
Entity Type:Individual
Prefix:
First Name:KINDA
Middle Name:CAMILLE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KINDA
Other - Middle Name:CAMILLE
Other - Last Name:MCMILLAN-ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:677 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5615
Mailing Address - Country:US
Mailing Address - Phone:718-570-2166
Mailing Address - Fax:
Practice Address - Street 1:677 E 39TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5615
Practice Address - Country:US
Practice Address - Phone:718-570-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist