Provider Demographics
NPI:1770644981
Name:MCMILLAN, PAULETTE (RD, LN, LAC)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:RD, LN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 DURHAM RD E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1420
Mailing Address - Country:US
Mailing Address - Phone:301-802-0500
Mailing Address - Fax:301-654-8552
Practice Address - Street 1:8218 WISCONSIN AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:301-654-9369
Practice Address - Fax:301-654-8552
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN00238133V00000X
MDU00832171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered171100000XOther Service ProvidersAcupuncturist