Provider Demographics
NPI:1093868937
Name:MILLIGAN, MELINDA LUANN (CNM)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:LUANN
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-0182
Mailing Address - Country:US
Mailing Address - Phone:360-376-4267
Mailing Address - Fax:360-376-4267
Practice Address - Street 1:273 CROW VALLEY RD.
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-0182
Practice Address - Country:US
Practice Address - Phone:360-376-4267
Practice Address - Fax:360-376-4267
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000532367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9604224Medicaid