Provider Demographics
NPI:1588021364
Name:MILLS, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:NITZSCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DVM
Mailing Address - Street 1:1202 SUSSEX TPKE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2939
Mailing Address - Country:US
Mailing Address - Phone:973-895-4999
Mailing Address - Fax:
Practice Address - Street 1:1202 SUSSEX TPKE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2939
Practice Address - Country:US
Practice Address - Phone:973-895-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29V100681300174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian