Provider Demographics
NPI:1912206194
Name:MILLAGE, JENNIFER M (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MILLAGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 WYLAND DR
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-1113
Mailing Address - Country:US
Mailing Address - Phone:605-201-2185
Mailing Address - Fax:605-428-2000
Practice Address - Street 1:1116 WYLAND DR
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1113
Practice Address - Country:US
Practice Address - Phone:605-201-2185
Practice Address - Fax:605-428-2000
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2011-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health