Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 097797 | MO |
NPI | 1124173042 |
---|---|
Provider Name | Terri L Milcic |
First Address | Saint Louis, MO 63128-2106 |
Second Address | Saint Louis, MO 63128-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |