Provider Demographics
NPI:1205136363
Name:MCMILLAN, GLORIA GENE (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:GENE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1667
Mailing Address - Country:US
Mailing Address - Phone:319-753-2300
Mailing Address - Fax:
Practice Address - Street 1:400 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9407
Practice Address - Country:US
Practice Address - Phone:319-768-5858
Practice Address - Fax:319-671-7030
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471937163WP0809X
IAA095667363LF0000X
IAG167077363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily