Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP127640 | TX |
NPI | 1043691116 |
---|---|
Provider Name | Mrs. Ricshonda Nicole Milburn |
First Address | Texas City, TX 77591-3130 |
Second Address | Galveston, TX 77555-0587 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2015 |
Last Update Date | 15/06/2015 |