Provider Demographics
NPI:1871666115
Name:PHILLIPS-MILLS, JENNY L (PAC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:PHILLIPS-MILLS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-045-5247
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:735 WILSON STREET
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412
Practice Address - Country:US
Practice Address - Phone:207-989-1567
Practice Address - Fax:207-664-5305
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAP077301Medicare PIN
S49411Medicare UPIN
AP0773Medicare Oscar/Certification
MEAP0773Medicare PIN
MES49411Medicare UPIN