Provider Demographics
NPI:1518967058
Name:MILLS, DAWN C (ANP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:C
Last Name:MILLS
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 1:110 NNPTC CIR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-6314
Mailing Address - Country:US
Mailing Address - Phone:843-577-5011
Mailing Address - Fax:
Practice Address - Street 1:2845 TRICOM ST
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9172
Practice Address - Country:US
Practice Address - Phone:843-797-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1416363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC54 60206OtherSTATE REGISTRATION NUMBER
SC1416OtherAPRN LISENSE
SC571134452OtherFEDERAL ID
SCNP0665Medicaid
SCGP3438Medicaid
SC98466OtherSC PCF
SCJBM01311OtherJUA
SC98466OtherSC PCF
SC7285Medicare ID - Type UnspecifiedGROUP
SCJBM01311OtherJUA
SCMM0667026OtherDEA NUMBER