Provider Demographics
NPI:1568806693
Name:MILLAR, THANAPOURN SUKHASAME (RN)
Entity Type:Individual
Prefix:
First Name:THANAPOURN
Middle Name:SUKHASAME
Last Name:MILLAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:THANA
Other - Middle Name:SUKHASAME
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 TOWNER ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5723
Mailing Address - Country:US
Mailing Address - Phone:734-544-3050
Mailing Address - Fax:734-544-6732
Practice Address - Street 1:110 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5503
Practice Address - Country:US
Practice Address - Phone:734-544-3050
Practice Address - Fax:734-544-6732
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2396513163W00000X
MI4704298046163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse