Provider Demographics
NPI:1649911934
Name:MILLS, MICHELLE RENA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENA
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 SAINT GALLEN LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6022
Mailing Address - Country:US
Mailing Address - Phone:469-213-8796
Mailing Address - Fax:
Practice Address - Street 1:1449 SAINT GALLEN LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6022
Practice Address - Country:US
Practice Address - Phone:469-213-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage