Provider Demographics
NPI:1801116082
Name:MILLS, ALICIA A (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:A
Last Name:MILLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SIR THOMAS CT STE 200
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4839
Mailing Address - Country:US
Mailing Address - Phone:177-240-7207
Mailing Address - Fax:717-724-0730
Practice Address - Street 1:815 SIR THOMAS CT STE 200
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4839
Practice Address - Country:US
Practice Address - Phone:177-240-7207
Practice Address - Fax:717-724-0730
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054371363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical