Provider Demographics
NPI:1497018121
Name:MCMILLAN, JENNIFER L (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 BOND ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-5334
Mailing Address - Country:US
Mailing Address - Phone:318-259-6601
Mailing Address - Fax:318-259-1146
Practice Address - Street 1:228 BOND ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-5334
Practice Address - Country:US
Practice Address - Phone:318-259-6601
Practice Address - Fax:318-259-1146
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN120624163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health