Provider Demographics
NPI:1396942306
Name:MILLS-JUDE, LYNDIS E (FNP)
Entity type:Individual
Prefix:MRS
First Name:LYNDIS
Middle Name:E
Last Name:MILLS-JUDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 MASON AVE
Mailing Address - Street 2:BUILDING B
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3408
Mailing Address - Country:US
Mailing Address - Phone:718-226-1300
Mailing Address - Fax:718-226-1259
Practice Address - Street 1:256 MASON AVE
Practice Address - Street 2:BUILDING B
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3408
Practice Address - Country:US
Practice Address - Phone:718-226-1300
Practice Address - Fax:718-226-1259
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03379077Medicaid
NY03379077Medicaid