Provider Demographics
NPI:1346915717
Name:MILAN, MAI T (CNP)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:T
Last Name:MILAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ELMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4545
Mailing Address - Country:US
Mailing Address - Phone:978-810-0259
Mailing Address - Fax:
Practice Address - Street 1:320 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1411
Practice Address - Country:US
Practice Address - Phone:978-655-5290
Practice Address - Fax:978-655-4525
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2273805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily