Provider Demographics
NPI:1770684433
Name:MILLS, CONSTANCE A (NP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:A
Last Name:MILLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 FRIEND ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3068
Mailing Address - Country:US
Mailing Address - Phone:781-715-6608
Mailing Address - Fax:
Practice Address - Street 1:37 FRIEND ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902
Practice Address - Country:US
Practice Address - Phone:781-715-6608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138247363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0394271Medicaid
MAS57243Medicare UPIN
MANP1153Medicare ID - Type Unspecified