Provider Demographics
NPI:1780911370
Name:MCMILLIAN, LORA DENISE (RN)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:DENISE
Last Name:MCMILLIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3220
Mailing Address - Country:US
Mailing Address - Phone:414-595-5132
Mailing Address - Fax:
Practice Address - Street 1:5500 N 56TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3220
Practice Address - Country:US
Practice Address - Phone:414-595-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI199041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse