Provider Demographics
NPI:1447588371
Name:MCMILLAN, SINCERE SIMONE (ANP)
Entity Type:Individual
Prefix:
First Name:SINCERE
Middle Name:SIMONE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 106TH ST
Mailing Address - Street 2:MEDICAL DEPARTMENT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3923
Mailing Address - Country:US
Mailing Address - Phone:212-870-5000
Mailing Address - Fax:
Practice Address - Street 1:120 W 106TH ST
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3923
Practice Address - Country:US
Practice Address - Phone:212-870-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305126363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health