Provider Demographics
NPI:1487416244
Name:MILLS, AMY M (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:MILLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:BEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:333-10 BLANCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9014
Mailing Address - Country:US
Mailing Address - Phone:509-280-9917
Mailing Address - Fax:
Practice Address - Street 1:1800 COOKS HILL RD STE G
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9162
Practice Address - Country:US
Practice Address - Phone:360-736-3042
Practice Address - Fax:360-736-2967
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00144883163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse