Provider Demographics
NPI:1790252815
Name:MCMILLAN, MARVA DENICE (MT)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:DENICE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9636
Mailing Address - Country:US
Mailing Address - Phone:509-422-5682
Mailing Address - Fax:509-422-7471
Practice Address - Street 1:617 BENTON ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9636
Practice Address - Country:US
Practice Address - Phone:509-422-5682
Practice Address - Fax:509-422-7471
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist