Provider Demographics
NPI:1437725058
Name:MILLWOOD, MARK LANDON JR (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LANDON
Last Name:MILLWOOD
Suffix:JR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 DEBARR RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2962
Mailing Address - Country:US
Mailing Address - Phone:907-206-4088
Mailing Address - Fax:907-318-9956
Practice Address - Street 1:2751 DEBARR RD STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2962
Practice Address - Country:US
Practice Address - Phone:907-206-4088
Practice Address - Fax:907-318-9956
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH077749-23363LP0808X
AK189420363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health