Provider Demographics
NPI:1952626772
Name:MILLS, LYNNEA (MD)
Entity Type:Individual
Prefix:
First Name:LYNNEA
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 PARNASSUS AVE
Mailing Address - Street 2:SUITE U127A, BOX 0131
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:533 PARNASSUS AVE
Practice Address - Street 2:SUITE U127A, BOX 0131
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0131
Practice Address - Country:US
Practice Address - Phone:415-476-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60299964207R00000X
CA131354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA314323OtherL&I
WA1952626772Medicaid
WA1952626772Medicaid