Provider Demographics
NPI:1689083545
Name:MILLS, MEGHAN MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MARIE
Last Name:MILLS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6058 UNIVERSITY HEIGHTS CIRLCE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1164
Mailing Address - Country:US
Mailing Address - Phone:330-280-3375
Mailing Address - Fax:
Practice Address - Street 1:201 DUEBER AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-1164
Practice Address - Country:US
Practice Address - Phone:330-453-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16226-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311527679Medicaid