Provider Demographics
NPI:1255961991
Name:MILLS, MARIA (LPN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15530-1005
Mailing Address - Country:US
Mailing Address - Phone:814-521-8923
Mailing Address - Fax:
Practice Address - Street 1:321 MAIN ST STE 4F
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1632
Practice Address - Country:US
Practice Address - Phone:814-254-4905
Practice Address - Fax:814-266-2880
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN295939164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse