Provider Demographics
NPI:1144511346
Name:MILBRY, GEVENA ARZELL (LPN,SWA,CDCA)
Entity type:Individual
Prefix:MRS
First Name:GEVENA
Middle Name:ARZELL
Last Name:MILBRY
Suffix:
Gender:F
Credentials:LPN,SWA,CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 BUCKLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2314
Mailing Address - Country:US
Mailing Address - Phone:937-529-4500
Mailing Address - Fax:
Practice Address - Street 1:4070 BUCKLEIGH WAY
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2314
Practice Address - Country:US
Practice Address - Phone:937-529-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN142895164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse