Provider Demographics
NPI:1669656203
Name:MILLAN, CONNIE D (LPN)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:D
Last Name:MILLAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 ANTOSKI
Mailing Address - Street 2:BOX 77
Mailing Address - City:GALENA
Mailing Address - State:AK
Mailing Address - Zip Code:99741-0077
Mailing Address - Country:US
Mailing Address - Phone:907-656-2366
Mailing Address - Fax:907-656-1525
Practice Address - Street 1:77 ANTOSKI
Practice Address - Street 2:BOX 77
Practice Address - City:GALENA
Practice Address - State:AK
Practice Address - Zip Code:99741-0077
Practice Address - Country:US
Practice Address - Phone:907-656-2366
Practice Address - Fax:907-656-1525
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8315164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse