Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | GA265340 | GA |
NPI | 1013687920 |
---|---|
Provider Name | Eleasa Milano |
First Address | Fayetteville, GA 30214-4181 |
Second Address | Fayetteville, GA 30214-4181 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2021 |
Last Update Date | 14/09/2021 |