Provider Demographics
NPI:1467036152
Name:MILBRUN, MISSY
Entity Type:Individual
Prefix:
First Name:MISSY
Middle Name:
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 1:186 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-5229
Mailing Address - Country:US
Mailing Address - Phone:203-979-4391
Mailing Address - Fax:
Practice Address - Street 1:186 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-5229
Practice Address - Country:US
Practice Address - Phone:203-979-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT376K00000X
374700000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No374700000XNursing Service Related ProvidersTechnician