Provider Demographics
NPI:1669644670
Name:MILLA, CARLOS POWELL (DNP)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:POWELL
Last Name:MILLA
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FULLING MILL LN
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3407
Mailing Address - Country:US
Mailing Address - Phone:203-417-4182
Mailing Address - Fax:
Practice Address - Street 1:6 FULLING MILL LN
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-3407
Practice Address - Country:US
Practice Address - Phone:203-417-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350086363L00000X
CT10687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner