Provider Demographics
NPI:1740855451
Name:MILHOLLAND, NICOLE LEE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:MILHOLLAND
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 1:2723 N 3853RD RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IL
Mailing Address - Zip Code:60551-9568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1394
Practice Address - Country:US
Practice Address - Phone:815-786-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist