Provider Demographics
NPI:1548804461
Name:MCMILLAN, EMILY (MBA, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MBA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 CANNON LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8376
Mailing Address - Country:US
Mailing Address - Phone:651-249-7257
Mailing Address - Fax:
Practice Address - Street 1:500 37TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3404
Practice Address - Country:US
Practice Address - Phone:507-289-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3978133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty