Provider Demographics
NPI:1326463233
Name:MILLETT, WANDA
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:MILLETT
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 1:17 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-3510
Mailing Address - Country:US
Mailing Address - Phone:603-702-0301
Mailing Address - Fax:
Practice Address - Street 1:17 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3510
Practice Address - Country:US
Practice Address - Phone:603-702-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner