Provider Demographics
NPI:1629511969
Name:MILLIKEN, AMANDA NICHOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICHOLE
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:NICHOLE
Other - Last Name:GORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:529 S PATTEN RD
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3007
Mailing Address - Country:US
Mailing Address - Phone:207-538-3700
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:30 HOULTON ST
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765-3035
Practice Address - Country:US
Practice Address - Phone:207-538-3700
Practice Address - Fax:207-528-2880
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN62742163W00000X
MECNP161193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse