Provider Demographics
NPI:1871087593
Name:MILL, MICHELLE SIMONEAU (LAC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SIMONEAU
Last Name:MILL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 SUN FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7705
Mailing Address - Country:US
Mailing Address - Phone:919-280-7496
Mailing Address - Fax:
Practice Address - Street 1:8356 SIX FORKS RD STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5094
Practice Address - Country:US
Practice Address - Phone:919-753-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128856163W00000X
NC940171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse