Provider Demographics
NPI:1538237045
Name:JARRELL, MILLIE L (CRNP)
Entity type:Individual
Prefix:MS
First Name:MILLIE
Middle Name:L
Last Name:JARRELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 DUNWOOD VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1245
Mailing Address - Country:US
Mailing Address - Phone:301-390-0730
Mailing Address - Fax:
Practice Address - Street 1:14100 DUNWOOD VALLEY DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1245
Practice Address - Country:US
Practice Address - Phone:301-390-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR068482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405446600Medicaid
MD641878-01OtherCAREFIRST MARYLAND
DC80390002OtherBLUE CROSS BLUE SHIELD DC
MD090MJ568Medicare ID - Type UnspecifiedMEDICARE MARYLAND
DC80390002OtherBLUE CROSS BLUE SHIELD DC
MD641878-01OtherCAREFIRST MARYLAND