Provider Demographics
NPI:1750142311
Name:MCMILLIAN, PORTIA RENEE (CNA)
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:RENEE
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 BEVERLYHILL ST APT 27
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6972
Mailing Address - Country:US
Mailing Address - Phone:346-395-7214
Mailing Address - Fax:
Practice Address - Street 1:5403 BEVERLYHILL ST APT 27
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6972
Practice Address - Country:US
Practice Address - Phone:346-395-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0008866462253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care