Provider Demographics
NPI:1376519355
Name:MILLS, CAROL ANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MILLS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6146 COTTONTAIL RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-1543
Mailing Address - Country:US
Mailing Address - Phone:505-249-0996
Mailing Address - Fax:
Practice Address - Street 1:6146 COTTONTAIL RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-1543
Practice Address - Country:US
Practice Address - Phone:505-249-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK255363LF0000X
NMR14155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK255OtherNURSE PRACTITIONER LICENSE
NMR14155OtherNURSING LICENSE
80456880OtherMEDICAID NEW MEXICO
NMR14155OtherNURSING LICENSE
80456880OtherMEDICAID NEW MEXICO
NMR14155OtherNURSING LICENSE
NMMM010619OtherDEA
AK255OtherNURSE PRACTITIONER LICENSE