Provider Demographics
NPI:1821136771
Name:ROTHMAN, MILLICENT (RN, BC, NP)
Entity Type:Individual
Prefix:MS
First Name:MILLICENT
Middle Name:
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:RN, BC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRAPELO RD
Mailing Address - Street 2:LIBERTY HEALTHCARE, FERNALD CENTER
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-6332
Mailing Address - Country:US
Mailing Address - Phone:781-894-3600
Mailing Address - Fax:781-398-0310
Practice Address - Street 1:200 TRAPELO RD
Practice Address - Street 2:LIBERTY HEALTHCARE, FERNALD CENTER
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-6332
Practice Address - Country:US
Practice Address - Phone:781-894-3600
Practice Address - Fax:781-398-0310
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106599363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3333Medicare ID - Type Unspecified