Provider Demographics
NPI:1235784596
Name:MILBRUN, MINDY ANNE
Entity Type:Individual
Prefix:MISS
First Name:MINDY
Middle Name:ANNE
Last Name:MILBRUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 BLACK ROCK TPKE UNIT C
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4744
Mailing Address - Country:US
Mailing Address - Phone:203-554-5949
Mailing Address - Fax:
Practice Address - Street 1:564 BLACK ROCK TPKE UNIT C
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4744
Practice Address - Country:US
Practice Address - Phone:203-554-5949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686140163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse