Provider Demographics
NPI:1881855716
Name:MCMILLAN, NICOLE LEE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 NW 85TH TER
Mailing Address - Street 2:APT B
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-3785
Mailing Address - Country:US
Mailing Address - Phone:573-225-7634
Mailing Address - Fax:
Practice Address - Street 1:3101 MAIN ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1921
Practice Address - Country:US
Practice Address - Phone:573-225-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist