Provider Demographics
NPI:1639510605
Name:MILLS, UNDRAY CONTAINE
Entity Type:Individual
Prefix:
First Name:UNDRAY
Middle Name:CONTAINE
Last Name:MILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7313 PEBBLESTONE DR APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-0020
Mailing Address - Country:US
Mailing Address - Phone:980-819-9474
Mailing Address - Fax:
Practice Address - Street 1:7313 PEBBLESTONE DR APT B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-0020
Practice Address - Country:US
Practice Address - Phone:980-819-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant