Provider Demographics
NPI:1720172455
Name:MILLS, CLAIRE L (FNP)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:L
Last Name:MILLS
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 1:690 GUZZI LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5289
Mailing Address - Country:US
Mailing Address - Phone:209-533-0333
Mailing Address - Fax:209-533-2749
Practice Address - Street 1:690 GUZZI LN
Practice Address - Street 2:SUITE C
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5289
Practice Address - Country:US
Practice Address - Phone:209-533-0333
Practice Address - Fax:209-533-2749
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2914363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR21444Medicare UPIN