Provider Demographics
NPI:1255712618
Name:MCMILLEN, MARIE (DO)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MCMILLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2710 SAINT FRANCIS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5664
Mailing Address - Country:US
Mailing Address - Phone:319-272-5000
Mailing Address - Fax:319-272-6730
Practice Address - Street 1:2710 SAINT FRANCIS DR STE 201
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5664
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:319-272-6730
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02005698B2084N0400X
AZR24892084N0400X
IADO-056142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology