Provider Demographics
NPI:1932519279
Name:MCMILLAN, LAKISHA LINDALE
Entity Type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:LINDALE
Last Name:MCMILLAN
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 1:1550 RUMSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4218
Mailing Address - Country:US
Mailing Address - Phone:201-937-5016
Mailing Address - Fax:
Practice Address - Street 1:1550 RUMSTONE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4218
Practice Address - Country:US
Practice Address - Phone:201-937-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide