Provider Demographics
NPI:1467971101
Name:MCMILLAN, JANE ROBICHAUD (RD, LD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ROBICHAUD
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13680 BENT TREE CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4562
Mailing Address - Country:US
Mailing Address - Phone:240-481-6801
Mailing Address - Fax:
Practice Address - Street 1:2639 CONNECTICUT AVE NW STE 251
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2651
Practice Address - Country:US
Practice Address - Phone:877-674-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered