Provider Demographics
NPI:1205729761
Name:MCMILLAN, CHERYL L (RN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:MCMILLAN
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 1:781 ROAD 23
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:KS
Mailing Address - Zip Code:67360-9039
Mailing Address - Country:US
Mailing Address - Phone:620-306-1256
Mailing Address - Fax:
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-577-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0083641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse