Provider Demographics
NPI:1578882767
Name:MILLS, HOLLY MARIE (RD, CDN)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:MARIE
Last Name:MILLS
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20901 42ND AVE
Mailing Address - Street 2:APT. # 2
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2780
Mailing Address - Country:US
Mailing Address - Phone:917-974-4619
Mailing Address - Fax:
Practice Address - Street 1:20901 42ND AVE
Practice Address - Street 2:APT. # 2
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2780
Practice Address - Country:US
Practice Address - Phone:917-974-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006516133N00000X
NY910404133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist