Provider Demographics
NPI:1225155997
Name:MILLESON, NIKI M (DO)
Entity Type:Individual
Prefix:MRS
First Name:NIKI
Middle Name:M
Last Name:MILLESON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 579
Mailing Address - Street 2:110 HOSPITAL LANE
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0579
Mailing Address - Country:US
Mailing Address - Phone:307-885-5852
Mailing Address - Fax:307-885-5889
Practice Address - Street 1:110 HOSPITAL LANE
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-0579
Practice Address - Country:US
Practice Address - Phone:307-885-5852
Practice Address - Fax:307-885-5889
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8420A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine