Provider Demographics
NPI:1174870778
Name:MILLS, NATHANIEL T (ARNP)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:T
Last Name:MILLS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 JOHN DEERE RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6898
Mailing Address - Country:US
Mailing Address - Phone:309-517-3036
Mailing Address - Fax:309-797-1088
Practice Address - Street 1:400 JOHN DEERE RD BLDG 1
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6898
Practice Address - Country:US
Practice Address - Phone:309-517-3036
Practice Address - Fax:309-797-1088
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAL-114465363LA2100X
IL209009784363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1174870778Medicaid