Provider Demographics
NPI:1275975740
Name:MILBURN, JOHN MICHAEL II (CNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:MILBURN
Suffix:II
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 E MILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1246
Mailing Address - Country:US
Mailing Address - Phone:330-422-3028
Mailing Address - Fax:
Practice Address - Street 1:450 W MAPLE ST STE 1
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9649
Practice Address - Country:US
Practice Address - Phone:330-882-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2019-08-05
Deactivation Date:2016-08-04
Deactivation Code:
Reactivation Date:2016-11-28
Provider Licenses
StateLicense IDTaxonomies
OHRN341255163W00000X
OHCOA15213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104160Medicaid