Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP007732 | PA |
NPI | 1013210764 |
---|---|
Provider Name | Melinda R Milliken |
First Address | Wynnewood, PA 19096 |
Second Address | Wynnewood, PA 19096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2010 |
Last Update Date | 17/12/2010 |