Provider Demographics
NPI:1821631581
Name:MILLAN, CINDY MARISOL (FNP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:MARISOL
Last Name:MILLAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 NE CUMULUS AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8805
Mailing Address - Country:US
Mailing Address - Phone:503-472-6161
Mailing Address - Fax:503-434-6290
Practice Address - Street 1:3825 WOLVERINE ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1201
Practice Address - Country:US
Practice Address - Phone:888-576-7526
Practice Address - Fax:503-391-9057
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201907344NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily