Provider Demographics
NPI:1730489089
Name:MCMILLAN, KRISTIN ANNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ANNE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ANNE
Other - Last Name:LIVELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 CREEK LOCKS RD
Mailing Address - Street 2:
Mailing Address - City:ROSENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12472
Mailing Address - Country:US
Mailing Address - Phone:845-336-0129
Mailing Address - Fax:
Practice Address - Street 1:3 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428
Practice Address - Country:US
Practice Address - Phone:845-647-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290578-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse