Provider Demographics
NPI:1528098308
Name:MILLS, LORI JANE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:JANE
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 1:9712 N 300 W
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-9726
Mailing Address - Country:US
Mailing Address - Phone:260-344-3435
Mailing Address - Fax:
Practice Address - Street 1:3151 E CENTER STREET EXT
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-3901
Practice Address - Country:US
Practice Address - Phone:574-267-3070
Practice Address - Fax:574-267-4813
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000419A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10000419AOtherSTATE LICENSE NUMBER
IN10000419BOtherCSR #