Provider Demographics
NPI:1780016915
Name:MCMILLAN, BENJAMIN JOEL (NP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JOEL
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2984
Mailing Address - Country:US
Mailing Address - Phone:910-674-4203
Mailing Address - Fax:910-674-4213
Practice Address - Street 1:3001 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2984
Practice Address - Country:US
Practice Address - Phone:910-674-4203
Practice Address - Fax:910-674-4213
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006315363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics