Provider Demographics
NPI:1972864312
Name:MILLA, JENNIFER R (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:MILLA
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 1:341 HOLLYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6117
Mailing Address - Country:US
Mailing Address - Phone:956-802-1170
Mailing Address - Fax:956-318-0137
Practice Address - Street 1:341 HOLLYWOOD DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6117
Practice Address - Country:US
Practice Address - Phone:956-802-1170
Practice Address - Fax:956-318-0137
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX614017171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator