Basic Information
Provider Information | |||||||||
NPI: | 1518967058 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MILLS | ||||||||
FirstName: | DAWN | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ANP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 110 NNPTC CIR | ||||||||
Address2: |   | ||||||||
City: | GOOSE CREEK | ||||||||
State: | SC | ||||||||
PostalCode: | 294456314 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8435775011 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2845 TRICOM ST | ||||||||
Address2: |   | ||||||||
City: | N CHARLESTON | ||||||||
State: | SC | ||||||||
PostalCode: | 294069172 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8437971770 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/27/2005 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 1416 | SC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
ID | Type | State | Issuer | Description | 54 60206 | 01 | SC | STATE REGISTRATION NUMBER | OTHER | 1416 | 01 | SC | APRN LISENSE | OTHER | 571134452 | 01 | SC | FEDERAL ID | OTHER | NP0665 | 05 | SC |   | MEDICAID | GP3438 | 05 | SC |   | MEDICAID | 98466 | 01 | SC | SC PCF | OTHER | JBM01311 | 01 | SC | JUA | OTHER |