Provider Demographics
NPI:1477520690
Name:MILBURN, DOROTHY (FNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:MILBURN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRAYMER
Mailing Address - State:MO
Mailing Address - Zip Code:64624-0036
Mailing Address - Country:US
Mailing Address - Phone:660-645-2218
Mailing Address - Fax:660-645-2820
Practice Address - Street 1:109 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRAYMER
Practice Address - State:MO
Practice Address - Zip Code:64624-0036
Practice Address - Country:US
Practice Address - Phone:660-645-2218
Practice Address - Fax:660-645-2820
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO153726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425991304Medicaid
145B921FMedicare ID - Type UnspecifiedPART B # HAMILTON CLINIC
145B921GMedicare ID - Type Unspecified
MO425991304Medicaid