Provider Demographics
NPI:1861195307
Name:MILLAR, ERICA (CNM)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MILLAR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11885 25TH CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-4531
Mailing Address - Country:US
Mailing Address - Phone:763-607-0183
Mailing Address - Fax:
Practice Address - Street 1:1515 S GREEN BAY RD STE 2
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4411
Practice Address - Country:US
Practice Address - Phone:262-355-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI150017-32367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife