Provider Demographics
NPI:1578397758
Name:MILLS, MIRANDA MARIE SR
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:MARIE
Last Name:MILLS
Suffix:SR
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 1:325 E WILBETH RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-2636
Mailing Address - Country:US
Mailing Address - Phone:234-863-1126
Mailing Address - Fax:
Practice Address - Street 1:1151 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1120
Practice Address - Country:US
Practice Address - Phone:330-803-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health