Provider Demographics
NPI:1952654931
Name:MCMILLIAN, ERICA (APRN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LENORE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-8016
Mailing Address - Country:US
Mailing Address - Phone:860-930-8014
Mailing Address - Fax:
Practice Address - Street 1:5 DURHAM RD
Practice Address - Street 2:BUILDING 3
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2076
Practice Address - Country:US
Practice Address - Phone:860-930-8014
Practice Address - Fax:203-458-9477
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health